Key clinical point: This meta-analysis demonstrated that the elevated pretreatment neutrophil-to-lymphocyte ratio (NLR) was correlated with poor long-term survival in patients with colorectal cancer (CRC) liver metastasis, including those who underwent surgery.

Major finding: Higher NLR was associated with poor overall survival (OS; hazard ratio [HR] 1.95; P < .01) and disease-free survival (DFS; HR 1.80; P < .01), and normal vs elevated NLR was associated with a better OS among patients who underwent surgery (HR 1.95; P < .01). The 5-year OS and DFS rates were higher in patients with normal vs high NLR (both P < .01).

Study details: The data come from a meta-analysis of 14 retrospective studies including 2974 participants.

Disclosures: This study was supported by the Startup Fund for Scientific Research, Fujian Medical University, China. No conflicts of interest were declared.

Source: Lin N et al. Prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer liver metastasis: A meta-analysis of results from multivariate analysis. Int J Surg. 2022;107:106959 (Oct 17). Doi: 10.1016/j.ijsu.2022.106959

Key clinical point: This meta-analysis demonstrated that the elevated pretreatment neutrophil-to-lymphocyte ratio (NLR) was correlated with poor long-term survival in patients with colorectal cancer (CRC) liver metastasis, including those who underwent surgery.

Major finding: Higher NLR was associated with poor overall survival (OS; hazard ratio [HR] 1.95; P < .01) and disease-free survival (DFS; HR 1.80; P < .01), and normal vs elevated NLR was associated with a better OS among patients who underwent surgery (HR 1.95; P < .01). The 5-year OS and DFS rates were higher in patients with normal vs high NLR (both P < .01).

Study details: The data come from a meta-analysis of 14 retrospective studies including 2974 participants.

Disclosures: This study was supported by the Startup Fund for Scientific Research, Fujian Medical University, China. No conflicts of interest were declared.

Source: Lin N et al. Prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer liver metastasis: A meta-analysis of results from multivariate analysis. Int J Surg. 2022;107:106959 (Oct 17). Doi: 10.1016/j.ijsu.2022.106959

Key clinical point: This meta-analysis demonstrated that the elevated pretreatment neutrophil-to-lymphocyte ratio (NLR) was correlated with poor long-term survival in patients with colorectal cancer (CRC) liver metastasis, including those who underwent surgery.

Major finding: Higher NLR was associated with poor overall survival (OS; hazard ratio [HR] 1.95; P < .01) and disease-free survival (DFS; HR 1.80; P < .01), and normal vs elevated NLR was associated with a better OS among patients who underwent surgery (HR 1.95; P < .01). The 5-year OS and DFS rates were higher in patients with normal vs high NLR (both P < .01).

Study details: The data come from a meta-analysis of 14 retrospective studies including 2974 participants.

Disclosures: This study was supported by the Startup Fund for Scientific Research, Fujian Medical University, China. No conflicts of interest were declared.

Source: Lin N et al. Prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer liver metastasis: A meta-analysis of results from multivariate analysis. Int J Surg. 2022;107:106959 (Oct 17). Doi: 10.1016/j.ijsu.2022.106959

Key clinical point: An early severe postoperative inflammatory response increased the risk for recurrence in patients with colorectal cancer (CRC) who underwent curative surgery, with the recurrence hazard being early and persistently higher in patients with high vs low C-reactive protein (CRP) levels.

Major finding: High vs low CRP levels was a significant predictor of worse 5-year RFS (adjusted hazard ratio 2.21; P < .001) with the hazard function peak being higher and earlier in the high (peak rate 0.0142; peak months 5.6) vs low (peak rate 0.0073; peak months 8.4) CRP group.

Study details: The data come from a retrospective study including 422 patients with stage I-IV CRC who underwent curative surgery and were followed for 5 years after surgery.

Disclosures: This study did not report the source of funding. No conflicts of interest were declared.

Source: Nakamura Y et al. Impact of severe postoperative inflammatory response on recurrence after curative resection of colorectal cancer. Int J Colorectal Dis. 2022;37(11):2375-2386 (Oct 24). Doi: 10.1007/s00384-022-04271-y

Key clinical point: An early severe postoperative inflammatory response increased the risk for recurrence in patients with colorectal cancer (CRC) who underwent curative surgery, with the recurrence hazard being early and persistently higher in patients with high vs low C-reactive protein (CRP) levels.

Major finding: High vs low CRP levels was a significant predictor of worse 5-year RFS (adjusted hazard ratio 2.21; P < .001) with the hazard function peak being higher and earlier in the high (peak rate 0.0142; peak months 5.6) vs low (peak rate 0.0073; peak months 8.4) CRP group.

Study details: The data come from a retrospective study including 422 patients with stage I-IV CRC who underwent curative surgery and were followed for 5 years after surgery.

Disclosures: This study did not report the source of funding. No conflicts of interest were declared.

Source: Nakamura Y et al. Impact of severe postoperative inflammatory response on recurrence after curative resection of colorectal cancer. Int J Colorectal Dis. 2022;37(11):2375-2386 (Oct 24). Doi: 10.1007/s00384-022-04271-y

Key clinical point: An early severe postoperative inflammatory response increased the risk for recurrence in patients with colorectal cancer (CRC) who underwent curative surgery, with the recurrence hazard being early and persistently higher in patients with high vs low C-reactive protein (CRP) levels.

Major finding: High vs low CRP levels was a significant predictor of worse 5-year RFS (adjusted hazard ratio 2.21; P < .001) with the hazard function peak being higher and earlier in the high (peak rate 0.0142; peak months 5.6) vs low (peak rate 0.0073; peak months 8.4) CRP group.

Study details: The data come from a retrospective study including 422 patients with stage I-IV CRC who underwent curative surgery and were followed for 5 years after surgery.

Disclosures: This study did not report the source of funding. No conflicts of interest were declared.

Source: Nakamura Y et al. Impact of severe postoperative inflammatory response on recurrence after curative resection of colorectal cancer. Int J Colorectal Dis. 2022;37(11):2375-2386 (Oct 24). Doi: 10.1007/s00384-022-04271-y

Key clinical point: Exposure to fluoropyrimidine-based adjuvant chemotherapy increased the risk for incident cardiovascular disease (CVD) in patients with high-risk stage II-III colorectal cancer (CRC) without preexisting CVD, highlighting the importance of cardiovascular risk monitoring.

Major finding: Patients with CRC receiving fluoropyrimidine-based adjuvant chemotherapy had a nearly 2-fold higher risk for CVD compared with control individuals without cancer (adjusted cause-specific hazard ratio 2.11; P < .001).

Study details: The data come from a population-based study including 1037 patients with high-risk stage II-III CRC treated with radical surgery followed by adjuvant chemotherapy, of which 102 patients received fluoropyrimidine-based adjuvant chemotherapy, and 5078 control individuals without cancer or a CVD history.

Disclosures: This study was supported by El Instituto de Salud Carlos III, Spain. The authors declared no conflicts of interest.

Source: Lee SF et al. Incident cardiovascular diseases among survivors of high-risk stage II-III colorectal cancer: A cluster-wide cohort study. J Natl Compr Canc Netw. 2022;20(10):1125-1133.e10 (Oct). Doi: 10.6004/jnccn.2022.7042

Key clinical point: Exposure to fluoropyrimidine-based adjuvant chemotherapy increased the risk for incident cardiovascular disease (CVD) in patients with high-risk stage II-III colorectal cancer (CRC) without preexisting CVD, highlighting the importance of cardiovascular risk monitoring.

Major finding: Patients with CRC receiving fluoropyrimidine-based adjuvant chemotherapy had a nearly 2-fold higher risk for CVD compared with control individuals without cancer (adjusted cause-specific hazard ratio 2.11; P < .001).

Study details: The data come from a population-based study including 1037 patients with high-risk stage II-III CRC treated with radical surgery followed by adjuvant chemotherapy, of which 102 patients received fluoropyrimidine-based adjuvant chemotherapy, and 5078 control individuals without cancer or a CVD history.

Disclosures: This study was supported by El Instituto de Salud Carlos III, Spain. The authors declared no conflicts of interest.

Source: Lee SF et al. Incident cardiovascular diseases among survivors of high-risk stage II-III colorectal cancer: A cluster-wide cohort study. J Natl Compr Canc Netw. 2022;20(10):1125-1133.e10 (Oct). Doi: 10.6004/jnccn.2022.7042

Key clinical point: Exposure to fluoropyrimidine-based adjuvant chemotherapy increased the risk for incident cardiovascular disease (CVD) in patients with high-risk stage II-III colorectal cancer (CRC) without preexisting CVD, highlighting the importance of cardiovascular risk monitoring.

Major finding: Patients with CRC receiving fluoropyrimidine-based adjuvant chemotherapy had a nearly 2-fold higher risk for CVD compared with control individuals without cancer (adjusted cause-specific hazard ratio 2.11; P < .001).

Study details: The data come from a population-based study including 1037 patients with high-risk stage II-III CRC treated with radical surgery followed by adjuvant chemotherapy, of which 102 patients received fluoropyrimidine-based adjuvant chemotherapy, and 5078 control individuals without cancer or a CVD history.

Disclosures: This study was supported by El Instituto de Salud Carlos III, Spain. The authors declared no conflicts of interest.

Source: Lee SF et al. Incident cardiovascular diseases among survivors of high-risk stage II-III colorectal cancer: A cluster-wide cohort study. J Natl Compr Canc Netw. 2022;20(10):1125-1133.e10 (Oct). Doi: 10.6004/jnccn.2022.7042

Key clinical point: The presence of synchronous ovarian metastases was not associated with a reduced 3-year overall survival (OS) in females with stage IV colorectal cancer (CRC).

Major finding: The 3-year OS rate was not significantly different between patients with vs without ovarian metastases (6.8% vs 8.0%; P = .607), with the median OS not being significantly different among patients with vs without ovarian metastases (adjusted hazard ratio 0.81; 95% CI 0.61-1.09).

Study details: The data come from a propensity score-matched analysis including 5253 female patients with stage IV CRC who received systemic therapy with palliative intent, of which 159 women with ovarian metastases were propensity matched with 159 women without ovarian metastases.

Disclosures: No information on funding source was available. No conflicts of interest were declared.

Source: van der Meer R et al. A propensity score-matched analysis of oncological outcome after systemic therapy for stage IV colorectal cancer: Impact of synchronous ovarian metastases. Int J Cancer. 2022 (Oct 17). Doi: 10.1002/ijc.343205

Key clinical point: The presence of synchronous ovarian metastases was not associated with a reduced 3-year overall survival (OS) in females with stage IV colorectal cancer (CRC).

Major finding: The 3-year OS rate was not significantly different between patients with vs without ovarian metastases (6.8% vs 8.0%; P = .607), with the median OS not being significantly different among patients with vs without ovarian metastases (adjusted hazard ratio 0.81; 95% CI 0.61-1.09).

Study details: The data come from a propensity score-matched analysis including 5253 female patients with stage IV CRC who received systemic therapy with palliative intent, of which 159 women with ovarian metastases were propensity matched with 159 women without ovarian metastases.

Disclosures: No information on funding source was available. No conflicts of interest were declared.

Source: van der Meer R et al. A propensity score-matched analysis of oncological outcome after systemic therapy for stage IV colorectal cancer: Impact of synchronous ovarian metastases. Int J Cancer. 2022 (Oct 17). Doi: 10.1002/ijc.343205

Key clinical point: The presence of synchronous ovarian metastases was not associated with a reduced 3-year overall survival (OS) in females with stage IV colorectal cancer (CRC).

Major finding: The 3-year OS rate was not significantly different between patients with vs without ovarian metastases (6.8% vs 8.0%; P = .607), with the median OS not being significantly different among patients with vs without ovarian metastases (adjusted hazard ratio 0.81; 95% CI 0.61-1.09).

Study details: The data come from a propensity score-matched analysis including 5253 female patients with stage IV CRC who received systemic therapy with palliative intent, of which 159 women with ovarian metastases were propensity matched with 159 women without ovarian metastases.

Disclosures: No information on funding source was available. No conflicts of interest were declared.

Source: van der Meer R et al. A propensity score-matched analysis of oncological outcome after systemic therapy for stage IV colorectal cancer: Impact of synchronous ovarian metastases. Int J Cancer. 2022 (Oct 17). Doi: 10.1002/ijc.343205

Key clinical point: The combination of CXD101 and nivolumab at full individual doses was effective and well tolerated as a third-line and above treatment for patients with late-stage microsatellite stable colorectal cancer (MSS CRC).

Major finding: CXD101 and nivolumab combination was well tolerated, with neutropenia (18%) and anemia (7%) being the most common grade 3-4 adverse events. The median progression-free survival and overall survival were 2.1 (95% CI 1.4-3.9) and 7.0 (95% CI 5.13-10.22) months, respectively, with an immune disease control rate of 48% and an immune objective response rate of 9%.

Study details: The data comes from a phase 1b/2 trial including 55 heavily pretreated patients with biopsy-confirmed MSS CRC who received oral CXD101 and intravenous nivolumab.

Disclosures: The trial was supported by Celleron Therapeutics. This study was funded by The Oxford NIHR Comprehensive Biomedical Research Centre and a Cancer Research UK Advanced Clinician Scientist Fellowship. Some authors declared being employees of or holding shares or share options in Celleron Therapeutics.

Source: Saunders MP et al. CXD101 and nivolumab in patients with metastatic microsatellite-stable colorectal cancer (CAROSELL): A multicentre, open-label, single-arm, phase II trial. ESMO Open. 2022;7(6):100594 (Oct 27). Doi: 10.1016/j.esmoop.2022.100594

Key clinical point: The combination of CXD101 and nivolumab at full individual doses was effective and well tolerated as a third-line and above treatment for patients with late-stage microsatellite stable colorectal cancer (MSS CRC).

Major finding: CXD101 and nivolumab combination was well tolerated, with neutropenia (18%) and anemia (7%) being the most common grade 3-4 adverse events. The median progression-free survival and overall survival were 2.1 (95% CI 1.4-3.9) and 7.0 (95% CI 5.13-10.22) months, respectively, with an immune disease control rate of 48% and an immune objective response rate of 9%.

Study details: The data comes from a phase 1b/2 trial including 55 heavily pretreated patients with biopsy-confirmed MSS CRC who received oral CXD101 and intravenous nivolumab.

Disclosures: The trial was supported by Celleron Therapeutics. This study was funded by The Oxford NIHR Comprehensive Biomedical Research Centre and a Cancer Research UK Advanced Clinician Scientist Fellowship. Some authors declared being employees of or holding shares or share options in Celleron Therapeutics.

Source: Saunders MP et al. CXD101 and nivolumab in patients with metastatic microsatellite-stable colorectal cancer (CAROSELL): A multicentre, open-label, single-arm, phase II trial. ESMO Open. 2022;7(6):100594 (Oct 27). Doi: 10.1016/j.esmoop.2022.100594

Key clinical point: The combination of CXD101 and nivolumab at full individual doses was effective and well tolerated as a third-line and above treatment for patients with late-stage microsatellite stable colorectal cancer (MSS CRC).

Major finding: CXD101 and nivolumab combination was well tolerated, with neutropenia (18%) and anemia (7%) being the most common grade 3-4 adverse events. The median progression-free survival and overall survival were 2.1 (95% CI 1.4-3.9) and 7.0 (95% CI 5.13-10.22) months, respectively, with an immune disease control rate of 48% and an immune objective response rate of 9%.

Study details: The data comes from a phase 1b/2 trial including 55 heavily pretreated patients with biopsy-confirmed MSS CRC who received oral CXD101 and intravenous nivolumab.

Disclosures: The trial was supported by Celleron Therapeutics. This study was funded by The Oxford NIHR Comprehensive Biomedical Research Centre and a Cancer Research UK Advanced Clinician Scientist Fellowship. Some authors declared being employees of or holding shares or share options in Celleron Therapeutics.

Source: Saunders MP et al. CXD101 and nivolumab in patients with metastatic microsatellite-stable colorectal cancer (CAROSELL): A multicentre, open-label, single-arm, phase II trial. ESMO Open. 2022;7(6):100594 (Oct 27). Doi: 10.1016/j.esmoop.2022.100594

Key clinical point: Patients with stage III colon cancer (CC) who received >50% of the planned 6-month oxaliplatin-based chemotherapy may discontinue oxaliplatin and continue fluoropyrimidine in case of clinically relevant neurotoxicity.

Major finding: Discontinuation of all treatment (DT) vs no DT was independently associated with worse 3-year disease-free survival (DFS, adjusted hazard ratio [aHR] 1.61; P < .001) and 5-year overall survival (OS aHR, 1.73; P < .001), but discontinuation of oxaliplatin had no effect on 3-year DFS (P = .3) and 5-year OS (P = .1). However, patients receiving <50% vs 100% of the planned oxaliplatin cycles had poorer DFS (aHR 1.34; 95% CI 1.10-1.64) and OS (aHR 1.61; 95% CI 1.29-2.01).

Study details: This pooled analysis of 11 adjuvant trials included patients with stage III CC who were to receive 6 months of infusional fluorouracil+leucovorin+oxaliplatin or capecitabine+oxaliplatin.

Disclosures: No funding source was declared. Some authors declared employment, stock, or other ownership interest in or receiving research support, speakers' fee, or consultancy fees from various sources.

Source: Gallois C et al. Prognostic impact of early treatment and oxaliplatin discontinuation in patients with stage III colon cancer: An ACCENT/IDEA pooled analysis of 11 adjuvant trials. J Clin Oncol. 2022 (Oct 28). Doi: 10.1200/JCO.21.02726

Key clinical point: Patients with stage III colon cancer (CC) who received >50% of the planned 6-month oxaliplatin-based chemotherapy may discontinue oxaliplatin and continue fluoropyrimidine in case of clinically relevant neurotoxicity.

Major finding: Discontinuation of all treatment (DT) vs no DT was independently associated with worse 3-year disease-free survival (DFS, adjusted hazard ratio [aHR] 1.61; P < .001) and 5-year overall survival (OS aHR, 1.73; P < .001), but discontinuation of oxaliplatin had no effect on 3-year DFS (P = .3) and 5-year OS (P = .1). However, patients receiving <50% vs 100% of the planned oxaliplatin cycles had poorer DFS (aHR 1.34; 95% CI 1.10-1.64) and OS (aHR 1.61; 95% CI 1.29-2.01).

Study details: This pooled analysis of 11 adjuvant trials included patients with stage III CC who were to receive 6 months of infusional fluorouracil+leucovorin+oxaliplatin or capecitabine+oxaliplatin.

Disclosures: No funding source was declared. Some authors declared employment, stock, or other ownership interest in or receiving research support, speakers' fee, or consultancy fees from various sources.

Source: Gallois C et al. Prognostic impact of early treatment and oxaliplatin discontinuation in patients with stage III colon cancer: An ACCENT/IDEA pooled analysis of 11 adjuvant trials. J Clin Oncol. 2022 (Oct 28). Doi: 10.1200/JCO.21.02726

Key clinical point: Patients with stage III colon cancer (CC) who received >50% of the planned 6-month oxaliplatin-based chemotherapy may discontinue oxaliplatin and continue fluoropyrimidine in case of clinically relevant neurotoxicity.

Major finding: Discontinuation of all treatment (DT) vs no DT was independently associated with worse 3-year disease-free survival (DFS, adjusted hazard ratio [aHR] 1.61; P < .001) and 5-year overall survival (OS aHR, 1.73; P < .001), but discontinuation of oxaliplatin had no effect on 3-year DFS (P = .3) and 5-year OS (P = .1). However, patients receiving <50% vs 100% of the planned oxaliplatin cycles had poorer DFS (aHR 1.34; 95% CI 1.10-1.64) and OS (aHR 1.61; 95% CI 1.29-2.01).

Study details: This pooled analysis of 11 adjuvant trials included patients with stage III CC who were to receive 6 months of infusional fluorouracil+leucovorin+oxaliplatin or capecitabine+oxaliplatin.

Disclosures: No funding source was declared. Some authors declared employment, stock, or other ownership interest in or receiving research support, speakers' fee, or consultancy fees from various sources.

Source: Gallois C et al. Prognostic impact of early treatment and oxaliplatin discontinuation in patients with stage III colon cancer: An ACCENT/IDEA pooled analysis of 11 adjuvant trials. J Clin Oncol. 2022 (Oct 28). Doi: 10.1200/JCO.21.02726

Key clinical point: Participants invited to undergo a single screening colonoscopy had a modestly reduced risk for colorectal cancer (CRC) at 10 years than those who were assigned to no screening.

Major finding: At 10 years, the real-world risk for CRC was 18% lower among participants who were invited vs not invited to undergo screening colonoscopy (risk ratio 0.82; 95% CI 0.70-0.93), with the number needed to invite to undergo screening to prevent 1 case of CRC within 10 years being 455 (95% CI 270-1,429).

Study details: The findings are 10-year follow-up results of the NordICC trial including 84,585 participants who were randomly assigned to receive (invited group; n = 28,220) or not receive (usual-care group; n = 56,365) an invitation to undergo a single screening colonoscopy.

Disclosures: This study was funded by the Research Council of Norway, Nordic Cancer Union, and others. Some authors declared serving as expert witnesses or consultants for or receiving research support, speakers' fees, or consultancy fees from various sources.

Source: Bretthauer M et al. Effect of colonoscopy screening on risks of colorectal cancer and related death. N Engl J Med. 2022;387(17):1547-1556 (Oct 27). Doi: 10.1056/NEJMoa2208375

Key clinical point: Participants invited to undergo a single screening colonoscopy had a modestly reduced risk for colorectal cancer (CRC) at 10 years than those who were assigned to no screening.

Major finding: At 10 years, the real-world risk for CRC was 18% lower among participants who were invited vs not invited to undergo screening colonoscopy (risk ratio 0.82; 95% CI 0.70-0.93), with the number needed to invite to undergo screening to prevent 1 case of CRC within 10 years being 455 (95% CI 270-1,429).

Study details: The findings are 10-year follow-up results of the NordICC trial including 84,585 participants who were randomly assigned to receive (invited group; n = 28,220) or not receive (usual-care group; n = 56,365) an invitation to undergo a single screening colonoscopy.

Disclosures: This study was funded by the Research Council of Norway, Nordic Cancer Union, and others. Some authors declared serving as expert witnesses or consultants for or receiving research support, speakers' fees, or consultancy fees from various sources.

Source: Bretthauer M et al. Effect of colonoscopy screening on risks of colorectal cancer and related death. N Engl J Med. 2022;387(17):1547-1556 (Oct 27). Doi: 10.1056/NEJMoa2208375

Key clinical point: Participants invited to undergo a single screening colonoscopy had a modestly reduced risk for colorectal cancer (CRC) at 10 years than those who were assigned to no screening.

Major finding: At 10 years, the real-world risk for CRC was 18% lower among participants who were invited vs not invited to undergo screening colonoscopy (risk ratio 0.82; 95% CI 0.70-0.93), with the number needed to invite to undergo screening to prevent 1 case of CRC within 10 years being 455 (95% CI 270-1,429).

Study details: The findings are 10-year follow-up results of the NordICC trial including 84,585 participants who were randomly assigned to receive (invited group; n = 28,220) or not receive (usual-care group; n = 56,365) an invitation to undergo a single screening colonoscopy.

Disclosures: This study was funded by the Research Council of Norway, Nordic Cancer Union, and others. Some authors declared serving as expert witnesses or consultants for or receiving research support, speakers' fees, or consultancy fees from various sources.

Source: Bretthauer M et al. Effect of colonoscopy screening on risks of colorectal cancer and related death. N Engl J Med. 2022;387(17):1547-1556 (Oct 27). Doi: 10.1056/NEJMoa2208375

Brain indicators of motor impairment were distinct among children with autism spectrum disorder (ASD), those with developmental coordination disorder (DCD), and controls, in a new study.

Previous research suggests that individuals with ASD overlap in motor impairment with those with DCD. But these two conditions may differ significantly in some areas, as children with ASD tend to show weaker skills in social motor tasks such as imitation, wrote Emil Kilroy, PhD, of the University of Southern California, Los Angeles, and colleagues.

The neurobiological basis of autism remains unknown, despite many research efforts, in part because of the heterogeneity of the disease, said corresponding author Lisa Aziz-Zadeh, PhD, also of the University of Southern California, in an interview.

Comorbidity with other disorders is a strong contributing factor to heterogeneity, and approximately 80% of autistic individuals have motor impairments and meet criteria for a diagnosis of DCD, said Dr. Aziz-Zadeh. “Controlling for other comorbidities, such as developmental coordination disorder, when trying to understand the neural basis of autism is important, so that we can understand which neural circuits are related to [core symptoms of autism] and which ones are related to motor impairments that are comorbid with autism, but not necessarily part of the core symptomology,” she explained. “We focused on white matter pathways here because many researchers now think the underlying basis of autism, besides genetics, is brain connectivity differences.”

In their study published in Scientific Reports, the researchers reviewed data from whole-brain correlational tractography for 22 individuals with autism spectrum disorder, 16 with developmental coordination disorder, and 21 normally developing individuals, who served as the control group. The mean age of the participants was approximately 11 years; the age range was 8-17 years.

Overall, patterns of brain diffusion (movement of fluid, mainly water molecules, in the brain) were significantly different in ASD children, compared with typically developing children.

The ASD group showed significantly reduced diffusivity in the bilateral fronto-parietal cingulum and the left parolfactory cingulum. This finding reflects previous studies suggesting an association between brain patterns in the cingulum area and ASD. But the current study is “the first to identify the fronto-parietal and the parolfactory portions of the cingulum as well as the anterior caudal u-fibers as specific to core ASD symptomatology and not related to motor-related comorbidity,” the researchers wrote.

Differences in brain diffusivity were associated with worse performance on motor skills and behavioral measures for children with ASD and children with DCD, compared with controls.

Motor development was assessed using the Total Movement Assessment Battery for Children-2 (MABC-2) and the Florida Apraxia Battery modified for children (FAB-M). The MABC-2 is among the most common tools for measuring motor skills and identifying clinically relevant motor deficits in children and teens aged 3-16 years. The test includes three subtest scores (manual dexterity, gross-motor aiming and catching, and balance) and a total score. Scores are based on a child’s best performance on each component, and higher scores indicate better functioning. In the new study, The MABC-2 total scores averaged 10.57 for controls, compared with 5.76 in the ASD group, and 4.31 in the DCD group.

Children with ASD differed from the other groups in social measures. Social skills were measured using several tools, including the Social Responsivity Scale (SRS Total), which is a parent-completed survey that includes a total score designed to reflect the severity of social deficits in ASD. It is divided into five subscales for parents to assess a child’s social skill impairment: social awareness, social cognition, social communication, social motivation, and mannerisms. Scores for the SRS are calculated in T-scores, in which a score of 50 represents the mean. T-scores of 59 and below are generally not associated with ASD, and patients with these scores are considered to have low to no symptomatology. Scores on the SRS Total in the new study were 45.95, 77.45, and 55.81 for the controls, ASD group, and DCD group, respectively.
 

Results should raise awareness

“The results were largely predicted in our hypotheses – that we would find specific white matter pathways in autism that would differ from [what we saw in typically developing patients and those with DCD], and that diffusivity in ASD would be related to socioemotional differences,” Dr. Aziz-Zadeh said, in an interview.

“What was surprising was that some pathways that had previously been thought to be different in autism were also compromised in DCD, indicating that they were common to motor deficits which both groups shared, not to core autism symptomology,” she noted.

A message for clinicians from the study is that a dual diagnosis of DCD is often missing in ASD practice, said Dr. Aziz-Zadeh. “Given that approximately 80% of children with ASD have DCD, testing for DCD and addressing potential motor issues should be more common practice,” she said.

Dr. Aziz-Zadeh and colleagues are now investigating relationships between the brain, behavior, and the gut microbiome. “We think that understanding autism from a full-body perspective, examining interactions between the brain and the body, will be an important step in this field,” she emphasized.

The study was limited by several factors, including the small sample size, the use of only right-handed participants, and the use of self-reports by children and parents, the researchers noted. Additionally, they noted that white matter develops at different rates in different age groups, and future studies might consider age as a factor, as well as further behavioral assessments, they said.
 

Small sample size limits conclusions

“Understanding the neuroanatomic differences that may contribute to the core symptoms of ASD is a very important goal for the field, particularly how they relate to other comorbid symptoms and neurodevelopmental disorders,” said Michael Gandal, MD, of the department of psychiatry at the University of Pennsylvania, Philadelphia, and a member of the Lifespan Brain Institute at the Children’s Hospital of Philadelphia, in an interview.

“While this study provides some clues into how structural connectivity may relate to motor coordination in ASD, it will be important to replicate these findings in a much larger sample before we can really appreciate how robust these findings are and how well they generalize to the broader ASD population,” Dr. Gandal emphasized.

The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The researchers had no financial conflicts to disclose. Dr. Gandal had no financial conflicts to disclose.

Brain indicators of motor impairment were distinct among children with autism spectrum disorder (ASD), those with developmental coordination disorder (DCD), and controls, in a new study.

Previous research suggests that individuals with ASD overlap in motor impairment with those with DCD. But these two conditions may differ significantly in some areas, as children with ASD tend to show weaker skills in social motor tasks such as imitation, wrote Emil Kilroy, PhD, of the University of Southern California, Los Angeles, and colleagues.

The neurobiological basis of autism remains unknown, despite many research efforts, in part because of the heterogeneity of the disease, said corresponding author Lisa Aziz-Zadeh, PhD, also of the University of Southern California, in an interview.

Comorbidity with other disorders is a strong contributing factor to heterogeneity, and approximately 80% of autistic individuals have motor impairments and meet criteria for a diagnosis of DCD, said Dr. Aziz-Zadeh. “Controlling for other comorbidities, such as developmental coordination disorder, when trying to understand the neural basis of autism is important, so that we can understand which neural circuits are related to [core symptoms of autism] and which ones are related to motor impairments that are comorbid with autism, but not necessarily part of the core symptomology,” she explained. “We focused on white matter pathways here because many researchers now think the underlying basis of autism, besides genetics, is brain connectivity differences.”

In their study published in Scientific Reports, the researchers reviewed data from whole-brain correlational tractography for 22 individuals with autism spectrum disorder, 16 with developmental coordination disorder, and 21 normally developing individuals, who served as the control group. The mean age of the participants was approximately 11 years; the age range was 8-17 years.

Overall, patterns of brain diffusion (movement of fluid, mainly water molecules, in the brain) were significantly different in ASD children, compared with typically developing children.

The ASD group showed significantly reduced diffusivity in the bilateral fronto-parietal cingulum and the left parolfactory cingulum. This finding reflects previous studies suggesting an association between brain patterns in the cingulum area and ASD. But the current study is “the first to identify the fronto-parietal and the parolfactory portions of the cingulum as well as the anterior caudal u-fibers as specific to core ASD symptomatology and not related to motor-related comorbidity,” the researchers wrote.

Differences in brain diffusivity were associated with worse performance on motor skills and behavioral measures for children with ASD and children with DCD, compared with controls.

Motor development was assessed using the Total Movement Assessment Battery for Children-2 (MABC-2) and the Florida Apraxia Battery modified for children (FAB-M). The MABC-2 is among the most common tools for measuring motor skills and identifying clinically relevant motor deficits in children and teens aged 3-16 years. The test includes three subtest scores (manual dexterity, gross-motor aiming and catching, and balance) and a total score. Scores are based on a child’s best performance on each component, and higher scores indicate better functioning. In the new study, The MABC-2 total scores averaged 10.57 for controls, compared with 5.76 in the ASD group, and 4.31 in the DCD group.

Children with ASD differed from the other groups in social measures. Social skills were measured using several tools, including the Social Responsivity Scale (SRS Total), which is a parent-completed survey that includes a total score designed to reflect the severity of social deficits in ASD. It is divided into five subscales for parents to assess a child’s social skill impairment: social awareness, social cognition, social communication, social motivation, and mannerisms. Scores for the SRS are calculated in T-scores, in which a score of 50 represents the mean. T-scores of 59 and below are generally not associated with ASD, and patients with these scores are considered to have low to no symptomatology. Scores on the SRS Total in the new study were 45.95, 77.45, and 55.81 for the controls, ASD group, and DCD group, respectively.
 

Results should raise awareness

“The results were largely predicted in our hypotheses – that we would find specific white matter pathways in autism that would differ from [what we saw in typically developing patients and those with DCD], and that diffusivity in ASD would be related to socioemotional differences,” Dr. Aziz-Zadeh said, in an interview.

“What was surprising was that some pathways that had previously been thought to be different in autism were also compromised in DCD, indicating that they were common to motor deficits which both groups shared, not to core autism symptomology,” she noted.

A message for clinicians from the study is that a dual diagnosis of DCD is often missing in ASD practice, said Dr. Aziz-Zadeh. “Given that approximately 80% of children with ASD have DCD, testing for DCD and addressing potential motor issues should be more common practice,” she said.

Dr. Aziz-Zadeh and colleagues are now investigating relationships between the brain, behavior, and the gut microbiome. “We think that understanding autism from a full-body perspective, examining interactions between the brain and the body, will be an important step in this field,” she emphasized.

The study was limited by several factors, including the small sample size, the use of only right-handed participants, and the use of self-reports by children and parents, the researchers noted. Additionally, they noted that white matter develops at different rates in different age groups, and future studies might consider age as a factor, as well as further behavioral assessments, they said.
 

Small sample size limits conclusions

“Understanding the neuroanatomic differences that may contribute to the core symptoms of ASD is a very important goal for the field, particularly how they relate to other comorbid symptoms and neurodevelopmental disorders,” said Michael Gandal, MD, of the department of psychiatry at the University of Pennsylvania, Philadelphia, and a member of the Lifespan Brain Institute at the Children’s Hospital of Philadelphia, in an interview.

“While this study provides some clues into how structural connectivity may relate to motor coordination in ASD, it will be important to replicate these findings in a much larger sample before we can really appreciate how robust these findings are and how well they generalize to the broader ASD population,” Dr. Gandal emphasized.

The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The researchers had no financial conflicts to disclose. Dr. Gandal had no financial conflicts to disclose.

Brain indicators of motor impairment were distinct among children with autism spectrum disorder (ASD), those with developmental coordination disorder (DCD), and controls, in a new study.

Previous research suggests that individuals with ASD overlap in motor impairment with those with DCD. But these two conditions may differ significantly in some areas, as children with ASD tend to show weaker skills in social motor tasks such as imitation, wrote Emil Kilroy, PhD, of the University of Southern California, Los Angeles, and colleagues.

The neurobiological basis of autism remains unknown, despite many research efforts, in part because of the heterogeneity of the disease, said corresponding author Lisa Aziz-Zadeh, PhD, also of the University of Southern California, in an interview.

Comorbidity with other disorders is a strong contributing factor to heterogeneity, and approximately 80% of autistic individuals have motor impairments and meet criteria for a diagnosis of DCD, said Dr. Aziz-Zadeh. “Controlling for other comorbidities, such as developmental coordination disorder, when trying to understand the neural basis of autism is important, so that we can understand which neural circuits are related to [core symptoms of autism] and which ones are related to motor impairments that are comorbid with autism, but not necessarily part of the core symptomology,” she explained. “We focused on white matter pathways here because many researchers now think the underlying basis of autism, besides genetics, is brain connectivity differences.”

In their study published in Scientific Reports, the researchers reviewed data from whole-brain correlational tractography for 22 individuals with autism spectrum disorder, 16 with developmental coordination disorder, and 21 normally developing individuals, who served as the control group. The mean age of the participants was approximately 11 years; the age range was 8-17 years.

Overall, patterns of brain diffusion (movement of fluid, mainly water molecules, in the brain) were significantly different in ASD children, compared with typically developing children.

The ASD group showed significantly reduced diffusivity in the bilateral fronto-parietal cingulum and the left parolfactory cingulum. This finding reflects previous studies suggesting an association between brain patterns in the cingulum area and ASD. But the current study is “the first to identify the fronto-parietal and the parolfactory portions of the cingulum as well as the anterior caudal u-fibers as specific to core ASD symptomatology and not related to motor-related comorbidity,” the researchers wrote.

Differences in brain diffusivity were associated with worse performance on motor skills and behavioral measures for children with ASD and children with DCD, compared with controls.

Motor development was assessed using the Total Movement Assessment Battery for Children-2 (MABC-2) and the Florida Apraxia Battery modified for children (FAB-M). The MABC-2 is among the most common tools for measuring motor skills and identifying clinically relevant motor deficits in children and teens aged 3-16 years. The test includes three subtest scores (manual dexterity, gross-motor aiming and catching, and balance) and a total score. Scores are based on a child’s best performance on each component, and higher scores indicate better functioning. In the new study, The MABC-2 total scores averaged 10.57 for controls, compared with 5.76 in the ASD group, and 4.31 in the DCD group.

Children with ASD differed from the other groups in social measures. Social skills were measured using several tools, including the Social Responsivity Scale (SRS Total), which is a parent-completed survey that includes a total score designed to reflect the severity of social deficits in ASD. It is divided into five subscales for parents to assess a child’s social skill impairment: social awareness, social cognition, social communication, social motivation, and mannerisms. Scores for the SRS are calculated in T-scores, in which a score of 50 represents the mean. T-scores of 59 and below are generally not associated with ASD, and patients with these scores are considered to have low to no symptomatology. Scores on the SRS Total in the new study were 45.95, 77.45, and 55.81 for the controls, ASD group, and DCD group, respectively.
 

Results should raise awareness

“The results were largely predicted in our hypotheses – that we would find specific white matter pathways in autism that would differ from [what we saw in typically developing patients and those with DCD], and that diffusivity in ASD would be related to socioemotional differences,” Dr. Aziz-Zadeh said, in an interview.

“What was surprising was that some pathways that had previously been thought to be different in autism were also compromised in DCD, indicating that they were common to motor deficits which both groups shared, not to core autism symptomology,” she noted.

A message for clinicians from the study is that a dual diagnosis of DCD is often missing in ASD practice, said Dr. Aziz-Zadeh. “Given that approximately 80% of children with ASD have DCD, testing for DCD and addressing potential motor issues should be more common practice,” she said.

Dr. Aziz-Zadeh and colleagues are now investigating relationships between the brain, behavior, and the gut microbiome. “We think that understanding autism from a full-body perspective, examining interactions between the brain and the body, will be an important step in this field,” she emphasized.

The study was limited by several factors, including the small sample size, the use of only right-handed participants, and the use of self-reports by children and parents, the researchers noted. Additionally, they noted that white matter develops at different rates in different age groups, and future studies might consider age as a factor, as well as further behavioral assessments, they said.
 

Small sample size limits conclusions

“Understanding the neuroanatomic differences that may contribute to the core symptoms of ASD is a very important goal for the field, particularly how they relate to other comorbid symptoms and neurodevelopmental disorders,” said Michael Gandal, MD, of the department of psychiatry at the University of Pennsylvania, Philadelphia, and a member of the Lifespan Brain Institute at the Children’s Hospital of Philadelphia, in an interview.

“While this study provides some clues into how structural connectivity may relate to motor coordination in ASD, it will be important to replicate these findings in a much larger sample before we can really appreciate how robust these findings are and how well they generalize to the broader ASD population,” Dr. Gandal emphasized.

The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The researchers had no financial conflicts to disclose. Dr. Gandal had no financial conflicts to disclose.

Intermittent fasting may reduce acid exposure time and improve symptoms for individuals with suspected gastroesophageal reflux disease (GERD), although the intervention may be hard to follow, suggests a small U.S. study.

Twenty-five individuals with suspected GERD symptoms underwent 96-hour pH monitoring. They were asked to follow their normal diet for the first 48 hours; for the second 48 hours, they were asked to switch to a 16-hour fast, which was followed by an 8-hour eating window.

Just over a third of participants were fully compliant with the 16:8 intermittent fasting. But those who followed the regimen experienced a mild reduction in mean acid exposure time and self-reported GERD symptoms scores.

The research was published online by the Journal of Clinical Gastroenterology.
 

Costly condition

The prevalence of GERD in the United States is estimated at 18%-28%. Annual costs of the condition are more than $18 billion per year, largely through pharmacologic therapies and diagnostic testing, write lead author Yan Jiang, MD, division of gastrointestinal and liver D-diseases, Keck Medicine of University of Southern California, Los Angeles, and colleagues.

Proton pump inhibitor (PPI) therapy is one of the most prescribed classes of medications in the United States, the authors write. But concerns over the long-term safety of the drugs, as well as the fact that half of patients report breakthrough GERD symptoms, have generated interest in non-PPI treatments among patients and providers.

The role of diet in the management of GERD, however, remains poorly understood, despite the fact that obesity and weight gain have been linked to reflux.

The authors note that intermittent fasting has shown benefits in coronary artery disease, inflammatory disorders, obesity, and diabetes. Proposed mechanisms include anti-inflammatory effects, weight loss, and alterations in hormone secretion.
 

Intervention test in a 96-hour clinical evaluation for GERD

To investigate the effects of intermittent fasting in GERD, the researchers screened patients referred to the Stanford University gastrointestinal clinic for diagnostic 96-hour ambulatory wireless pH monitoring of suspected acid reflux symptoms.

They excluded patients younger than 18 years, pregnant women, those with insulin-dependent diabetes, and those who had used PPIs within the previous 7 days. There were other exclusion criteria as well.

The study was completed by 25 participants. The mean age of the patients was 43.5 years; 52% were women. Just under half (44%) were White, and the mean body mass index was 25.8 kg/m².

For the first 48 hours of the pH monitoring, the patients followed their baseline diet. For the second 48 hours, they were asked to follow an intermittent fasting regimen.

In that regimen, during a 24-hour period, there was an 8-hour caloric intake window and no caloric intake during the other 16 consecutive hours. Participants who fasted for at least 15 hours, as indicated on a self-report food log, were considered successful.

Only 36% of participants were fully adherent to the fasting regimen; 84% were partially compliant, defined as following the regimen for at least 1 of the 2 days of intermittent fasting.

On intermittent fasting days, the mean acid exposure time was 3.5%, compared with 4.3% on the baseline diet. The team calculated that adhering to the 16:8 intermittent fasting regimen reduced the mean acid exposure time by 0.64%.

Intermittent fasting was also associated with a reduction in total GERD symptom scores, at 9.9 following day 4 versus 14.3 following day 2. There were reductions in heartburn symptoms scores of 2.6 and in regurgitation scores of 1.8.

When the researchers compared individuals who were compliant with intermittent fasting with those who were only partially compliant, they found that there was still an improvement in GERD symptoms, with a reduction in scores of 3.2.
 

More acid, bigger benefits

There could be several explanations for the findings, Dr. Jiang said in an interview.

In the short-term study, fewer meals during intermittent fasting and more hours between the last meal and bedtime can help with the supine symptoms of GERD, Dr. Jiang said.

Over the longer term, he added, previous studies have suggested that fasting-induced alterations in inflammatory cytokines or cells could be a contributory mechanism, “but it’s not something that we can glean from our study.”

Participants with elevated acid exposure at baseline and who were more likely to have GERD diagnosed by the pH monitoring seemed to experience the greatest benefit from intermittent fasting, Dr. Jiang pointed out.

“This study looked at all comers with GERD symptoms,” he said. “But if you were to do another study with people with proven GERD, they might experience a bigger impact with intermittent fasting.”

Dr. Jiang added, “If a patient is willing to do intermittent fasting, and certainly if they have other reasons [for doing so], I think it doesn’t hurt, and it might actually help them a little bit in their current symptoms.”
 

Larger scale, longer follow-up studies needed

Luigi Bonavina, MD, department of biomedical sciences for health, University of Milan, IRCCS Policlinico San Donato, Italy, said in an interview that it was a “nice, original study.”

It is “noteworthy that only one previous study explored the effect of Ramadan on GERD symptoms and found a small improvement of GERD symptoms,” Dr. Bonavina said. “Unfortunately, the magnitude of effect [in the current study] was not as one may have expected, due to small sample size and low compliance with intermittent fasting.”

Although the effect was “mild compared to that seen with PPIs,” it would “be interesting to see whether the results of this pilot, proof-of-concept study can be confirmed on a larger scale with longer follow-up to prove that reflux symptoms will not worsen over time,” he said.

“Intermittent fasting may be recommended, especially in overweight-obese patients with GERD symptoms who are poor responders to gastric acid inhibitors,” Dr. Bonavina added. “Reduction of inflammation, reduction of meal intake, and going to bed with an empty stomach may also work in patients with GERD.”

No funding for the study has been declared. The authors and Dr. Bonavina report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Intermittent fasting may reduce acid exposure time and improve symptoms for individuals with suspected gastroesophageal reflux disease (GERD), although the intervention may be hard to follow, suggests a small U.S. study.

Twenty-five individuals with suspected GERD symptoms underwent 96-hour pH monitoring. They were asked to follow their normal diet for the first 48 hours; for the second 48 hours, they were asked to switch to a 16-hour fast, which was followed by an 8-hour eating window.

Just over a third of participants were fully compliant with the 16:8 intermittent fasting. But those who followed the regimen experienced a mild reduction in mean acid exposure time and self-reported GERD symptoms scores.

The research was published online by the Journal of Clinical Gastroenterology.
 

Costly condition

The prevalence of GERD in the United States is estimated at 18%-28%. Annual costs of the condition are more than $18 billion per year, largely through pharmacologic therapies and diagnostic testing, write lead author Yan Jiang, MD, division of gastrointestinal and liver D-diseases, Keck Medicine of University of Southern California, Los Angeles, and colleagues.

Proton pump inhibitor (PPI) therapy is one of the most prescribed classes of medications in the United States, the authors write. But concerns over the long-term safety of the drugs, as well as the fact that half of patients report breakthrough GERD symptoms, have generated interest in non-PPI treatments among patients and providers.

The role of diet in the management of GERD, however, remains poorly understood, despite the fact that obesity and weight gain have been linked to reflux.

The authors note that intermittent fasting has shown benefits in coronary artery disease, inflammatory disorders, obesity, and diabetes. Proposed mechanisms include anti-inflammatory effects, weight loss, and alterations in hormone secretion.
 

Intervention test in a 96-hour clinical evaluation for GERD

To investigate the effects of intermittent fasting in GERD, the researchers screened patients referred to the Stanford University gastrointestinal clinic for diagnostic 96-hour ambulatory wireless pH monitoring of suspected acid reflux symptoms.

They excluded patients younger than 18 years, pregnant women, those with insulin-dependent diabetes, and those who had used PPIs within the previous 7 days. There were other exclusion criteria as well.

The study was completed by 25 participants. The mean age of the patients was 43.5 years; 52% were women. Just under half (44%) were White, and the mean body mass index was 25.8 kg/m².

For the first 48 hours of the pH monitoring, the patients followed their baseline diet. For the second 48 hours, they were asked to follow an intermittent fasting regimen.

In that regimen, during a 24-hour period, there was an 8-hour caloric intake window and no caloric intake during the other 16 consecutive hours. Participants who fasted for at least 15 hours, as indicated on a self-report food log, were considered successful.

Only 36% of participants were fully adherent to the fasting regimen; 84% were partially compliant, defined as following the regimen for at least 1 of the 2 days of intermittent fasting.

On intermittent fasting days, the mean acid exposure time was 3.5%, compared with 4.3% on the baseline diet. The team calculated that adhering to the 16:8 intermittent fasting regimen reduced the mean acid exposure time by 0.64%.

Intermittent fasting was also associated with a reduction in total GERD symptom scores, at 9.9 following day 4 versus 14.3 following day 2. There were reductions in heartburn symptoms scores of 2.6 and in regurgitation scores of 1.8.

When the researchers compared individuals who were compliant with intermittent fasting with those who were only partially compliant, they found that there was still an improvement in GERD symptoms, with a reduction in scores of 3.2.
 

More acid, bigger benefits

There could be several explanations for the findings, Dr. Jiang said in an interview.

In the short-term study, fewer meals during intermittent fasting and more hours between the last meal and bedtime can help with the supine symptoms of GERD, Dr. Jiang said.

Over the longer term, he added, previous studies have suggested that fasting-induced alterations in inflammatory cytokines or cells could be a contributory mechanism, “but it’s not something that we can glean from our study.”

Participants with elevated acid exposure at baseline and who were more likely to have GERD diagnosed by the pH monitoring seemed to experience the greatest benefit from intermittent fasting, Dr. Jiang pointed out.

“This study looked at all comers with GERD symptoms,” he said. “But if you were to do another study with people with proven GERD, they might experience a bigger impact with intermittent fasting.”

Dr. Jiang added, “If a patient is willing to do intermittent fasting, and certainly if they have other reasons [for doing so], I think it doesn’t hurt, and it might actually help them a little bit in their current symptoms.”
 

Larger scale, longer follow-up studies needed

Luigi Bonavina, MD, department of biomedical sciences for health, University of Milan, IRCCS Policlinico San Donato, Italy, said in an interview that it was a “nice, original study.”

It is “noteworthy that only one previous study explored the effect of Ramadan on GERD symptoms and found a small improvement of GERD symptoms,” Dr. Bonavina said. “Unfortunately, the magnitude of effect [in the current study] was not as one may have expected, due to small sample size and low compliance with intermittent fasting.”

Although the effect was “mild compared to that seen with PPIs,” it would “be interesting to see whether the results of this pilot, proof-of-concept study can be confirmed on a larger scale with longer follow-up to prove that reflux symptoms will not worsen over time,” he said.

“Intermittent fasting may be recommended, especially in overweight-obese patients with GERD symptoms who are poor responders to gastric acid inhibitors,” Dr. Bonavina added. “Reduction of inflammation, reduction of meal intake, and going to bed with an empty stomach may also work in patients with GERD.”

No funding for the study has been declared. The authors and Dr. Bonavina report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Intermittent fasting may reduce acid exposure time and improve symptoms for individuals with suspected gastroesophageal reflux disease (GERD), although the intervention may be hard to follow, suggests a small U.S. study.

Twenty-five individuals with suspected GERD symptoms underwent 96-hour pH monitoring. They were asked to follow their normal diet for the first 48 hours; for the second 48 hours, they were asked to switch to a 16-hour fast, which was followed by an 8-hour eating window.

Just over a third of participants were fully compliant with the 16:8 intermittent fasting. But those who followed the regimen experienced a mild reduction in mean acid exposure time and self-reported GERD symptoms scores.

The research was published online by the Journal of Clinical Gastroenterology.
 

Costly condition

The prevalence of GERD in the United States is estimated at 18%-28%. Annual costs of the condition are more than $18 billion per year, largely through pharmacologic therapies and diagnostic testing, write lead author Yan Jiang, MD, division of gastrointestinal and liver D-diseases, Keck Medicine of University of Southern California, Los Angeles, and colleagues.

Proton pump inhibitor (PPI) therapy is one of the most prescribed classes of medications in the United States, the authors write. But concerns over the long-term safety of the drugs, as well as the fact that half of patients report breakthrough GERD symptoms, have generated interest in non-PPI treatments among patients and providers.

The role of diet in the management of GERD, however, remains poorly understood, despite the fact that obesity and weight gain have been linked to reflux.

The authors note that intermittent fasting has shown benefits in coronary artery disease, inflammatory disorders, obesity, and diabetes. Proposed mechanisms include anti-inflammatory effects, weight loss, and alterations in hormone secretion.
 

Intervention test in a 96-hour clinical evaluation for GERD

To investigate the effects of intermittent fasting in GERD, the researchers screened patients referred to the Stanford University gastrointestinal clinic for diagnostic 96-hour ambulatory wireless pH monitoring of suspected acid reflux symptoms.

They excluded patients younger than 18 years, pregnant women, those with insulin-dependent diabetes, and those who had used PPIs within the previous 7 days. There were other exclusion criteria as well.

The study was completed by 25 participants. The mean age of the patients was 43.5 years; 52% were women. Just under half (44%) were White, and the mean body mass index was 25.8 kg/m².

For the first 48 hours of the pH monitoring, the patients followed their baseline diet. For the second 48 hours, they were asked to follow an intermittent fasting regimen.

In that regimen, during a 24-hour period, there was an 8-hour caloric intake window and no caloric intake during the other 16 consecutive hours. Participants who fasted for at least 15 hours, as indicated on a self-report food log, were considered successful.

Only 36% of participants were fully adherent to the fasting regimen; 84% were partially compliant, defined as following the regimen for at least 1 of the 2 days of intermittent fasting.

On intermittent fasting days, the mean acid exposure time was 3.5%, compared with 4.3% on the baseline diet. The team calculated that adhering to the 16:8 intermittent fasting regimen reduced the mean acid exposure time by 0.64%.

Intermittent fasting was also associated with a reduction in total GERD symptom scores, at 9.9 following day 4 versus 14.3 following day 2. There were reductions in heartburn symptoms scores of 2.6 and in regurgitation scores of 1.8.

When the researchers compared individuals who were compliant with intermittent fasting with those who were only partially compliant, they found that there was still an improvement in GERD symptoms, with a reduction in scores of 3.2.
 

More acid, bigger benefits

There could be several explanations for the findings, Dr. Jiang said in an interview.

In the short-term study, fewer meals during intermittent fasting and more hours between the last meal and bedtime can help with the supine symptoms of GERD, Dr. Jiang said.

Over the longer term, he added, previous studies have suggested that fasting-induced alterations in inflammatory cytokines or cells could be a contributory mechanism, “but it’s not something that we can glean from our study.”

Participants with elevated acid exposure at baseline and who were more likely to have GERD diagnosed by the pH monitoring seemed to experience the greatest benefit from intermittent fasting, Dr. Jiang pointed out.

“This study looked at all comers with GERD symptoms,” he said. “But if you were to do another study with people with proven GERD, they might experience a bigger impact with intermittent fasting.”

Dr. Jiang added, “If a patient is willing to do intermittent fasting, and certainly if they have other reasons [for doing so], I think it doesn’t hurt, and it might actually help them a little bit in their current symptoms.”
 

Larger scale, longer follow-up studies needed

Luigi Bonavina, MD, department of biomedical sciences for health, University of Milan, IRCCS Policlinico San Donato, Italy, said in an interview that it was a “nice, original study.”

It is “noteworthy that only one previous study explored the effect of Ramadan on GERD symptoms and found a small improvement of GERD symptoms,” Dr. Bonavina said. “Unfortunately, the magnitude of effect [in the current study] was not as one may have expected, due to small sample size and low compliance with intermittent fasting.”

Although the effect was “mild compared to that seen with PPIs,” it would “be interesting to see whether the results of this pilot, proof-of-concept study can be confirmed on a larger scale with longer follow-up to prove that reflux symptoms will not worsen over time,” he said.

“Intermittent fasting may be recommended, especially in overweight-obese patients with GERD symptoms who are poor responders to gastric acid inhibitors,” Dr. Bonavina added. “Reduction of inflammation, reduction of meal intake, and going to bed with an empty stomach may also work in patients with GERD.”

No funding for the study has been declared. The authors and Dr. Bonavina report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

More women gave birth at home in America last year, continuing a pandemic trend and reaching the highest level in decades, according to figures released by the CDC.

The report said that almost 52,000 births occurred at home in 2021, out of 4 million total births in the country. This was an increase of 12% from 2020. The figure rose by 22% in 2020, when the COVID-19 pandemic hit, over 2019.

There were several possible reasons for the increase in home births. Infection rates and hospitalizations were high. Vaccinations were not available or were not widely used, and many people avoided going to hospitals or the doctor, said Elizabeth Gregory, the report’s lead author.

Also, some women didn’t have health insurance, lived far from a medical facility, or could not get to a hospital fast enough. About 25% of home births are not planned, the Associated Press reported.

Increases in home births occurred across all races, but home births were less common among Hispanics.

The AP reported that home births are riskier than hospital births, according to the American College of Obstetricians and Gynecologists. The organization advises against home births for women carrying multiple babies or who have previously had a cesarean section.

“Hospitals and accredited birth centers are the safest places to give birth, because although serious complications associated with labor and delivery are rare, they can be catastrophic,” said Jeffrey Ecker, M.D., chief of obstetrics and gynecology at Massachusetts General Hospital, Boston.

A version of this article first appeared on WebMD.com.

More women gave birth at home in America last year, continuing a pandemic trend and reaching the highest level in decades, according to figures released by the CDC.

The report said that almost 52,000 births occurred at home in 2021, out of 4 million total births in the country. This was an increase of 12% from 2020. The figure rose by 22% in 2020, when the COVID-19 pandemic hit, over 2019.

There were several possible reasons for the increase in home births. Infection rates and hospitalizations were high. Vaccinations were not available or were not widely used, and many people avoided going to hospitals or the doctor, said Elizabeth Gregory, the report’s lead author.

Also, some women didn’t have health insurance, lived far from a medical facility, or could not get to a hospital fast enough. About 25% of home births are not planned, the Associated Press reported.

Increases in home births occurred across all races, but home births were less common among Hispanics.

The AP reported that home births are riskier than hospital births, according to the American College of Obstetricians and Gynecologists. The organization advises against home births for women carrying multiple babies or who have previously had a cesarean section.

“Hospitals and accredited birth centers are the safest places to give birth, because although serious complications associated with labor and delivery are rare, they can be catastrophic,” said Jeffrey Ecker, M.D., chief of obstetrics and gynecology at Massachusetts General Hospital, Boston.

A version of this article first appeared on WebMD.com.

More women gave birth at home in America last year, continuing a pandemic trend and reaching the highest level in decades, according to figures released by the CDC.

The report said that almost 52,000 births occurred at home in 2021, out of 4 million total births in the country. This was an increase of 12% from 2020. The figure rose by 22% in 2020, when the COVID-19 pandemic hit, over 2019.

There were several possible reasons for the increase in home births. Infection rates and hospitalizations were high. Vaccinations were not available or were not widely used, and many people avoided going to hospitals or the doctor, said Elizabeth Gregory, the report’s lead author.

Also, some women didn’t have health insurance, lived far from a medical facility, or could not get to a hospital fast enough. About 25% of home births are not planned, the Associated Press reported.

Increases in home births occurred across all races, but home births were less common among Hispanics.

The AP reported that home births are riskier than hospital births, according to the American College of Obstetricians and Gynecologists. The organization advises against home births for women carrying multiple babies or who have previously had a cesarean section.

“Hospitals and accredited birth centers are the safest places to give birth, because although serious complications associated with labor and delivery are rare, they can be catastrophic,” said Jeffrey Ecker, M.D., chief of obstetrics and gynecology at Massachusetts General Hospital, Boston.

A version of this article first appeared on WebMD.com.