Publisher Health

There is a surprising dearth of research about how breast cancer cells can go dormant, spread and then resurface years or even decades later, according to a new review of in vitro breast cancer studies conducted by researchers at the University of Massachusetts Amherst.
“[Our review found that] less than 1% of all these studies that combine cells with designer environments look at dormancy,” says Shelly Peyton, Provost Professor of Chemical Engineering. “It’s not enough. We just don’t understand what’s happening — and it’s killing patients.”
Breast cancer dormancy is a phenomenon in which breast cancer cells metastasize — or spread to different tissue sites throughout the body (typically the liver, lungs, brain or bones) — but don’t grow. “They’re not detectable or symptomatic tumors,” Peyton explains. “A patient will have their primary tumor removed and appear to be disease-free for months, years, even decades. And for reasons we don’t understand, something changes about the environment that causes those cells to start regrowing, and then you have a deadly metastasis.”
Patients with metastatic breast cancer have a 30% five-year survival rate, compared to a 99% survival rate for localized breast cancer. “Early detection is key, particularly in the Western world,” says Peyton. “You can have lumpectomies, radiation, small surgeries. And women can survive. It’s when that cancer has spread that it becomes much harder to treat.”
This relapse in distant organs impacts 40% of early-stage breast cancer patients, and breast cancer dormancy is a contributing factor. But while metastasis has known biomarkers, dormant cancer cells are very hard to identify.
“When you have a single dormant breast cancer cell that’s hiding in a distant tissue, it’s really hard to detect that,” says Nate Richbourg, lead author on the paper and postdoctoral researcher in the Peyton Lab. “And you don’t want to do an invasive biopsy or prescribe toxic chemotherapy for something that might not be a problem.”
With these challenges in mind, the review, published in Science Advances, aimed to identify gaps in the research, particularly focusing on in vitro studies, or research using benchtop-model environments instead of animal models or humans. In vitro studies allow for the precise control of the environment, which Peyton’s research group says may play a deciding role in whether a cell remains dormant or reactivates into a deadly metastatic tumor.

“What can we control in these artificial environments that will give us insight into how breast cancer dormancy happens, and what we can do to treat it as well?” Richbourg asks, describing the importance of in vitro modeling. “When we create this artificial dormancy, we can see how many of those cells could turn back into proliferating and potentially deadly cells.”
Their review highlights just how complex the role of the environment is. “If you have a [breast cancer] cell somewhere in the bone marrow, you’re going to have other cells there, the physical factors in your environment, and the biochemical factors,” Richbourg gives as an example. “We try to use reductive models to separate the thing that is influencing this behavior. But what we’re seeing is that everything works together to create this breast cancer dormancy effect. The better we can create models that capture all that nuance, the better we’re going to be able to understand it.”
For Peyton, their work is also a call to action. “The paper is calling out to the field that we need to do more,” she says. This includes being more creative with the materials that already exist and developing new materials; identifying ways to model the decades-long progression of dormancy that is impossible to recreate in a single study; and expanding the diversity of cell lines used for research (Richbourg points out that many of the studies they reviewed used the same cell line, MDA-MB-231, derived from one 40-to-50-year-old white woman).
Finally, the researchers have an eye to the ultimate goal: better treatments to save patients. “We see that that there are some clinical trials that are happening that are derived from some of those in vitro models,” says Ninette Irakoze, graduate student in the Peyton Lab. “The paper gives hope that, with more development of these in vitro models, eventually we could find treatments to eradicate dormant cancer.”

Men and women with lower income or education levels are more likely to develop medical conditions related to alcohol abuse compared to similar individuals with a higher socioeconomic status. Alexis Edwards of Virginia Commonwealth University, US, and colleagues report these findings in a new study published March 19 in the open access journal PLOS Medicine.
The World Health Organization estimates that harmful alcohol use accounts for 5.1% of the global burden of disease and injury worldwide, and results in three million deaths each year. Excessive alcohol consumption can also take an economic toll. Previous studies have identified links between a person’s socioeconomic status and alcohol use, but currently it is unclear how an individual’s social class impacts their future risk of acquiring alcohol-related medical conditions, like alcoholic liver disease.
In the new study, researchers used a model that follows people over time to estimate their risk of developing medical conditions from alcohol abuse using two indicators for socioeconomic status: income and education level. The researchers analyzed data from more than 2.3 million individuals in a Swedish database to show that both men and women with a lower income or education level were more likely to develop these conditions. The associations held true, even when researchers controlled for other relevant factors, such as marital status, history of psychiatric illness and having a genetic predisposition to abuse alcohol.
The new findings are important for understanding which populations are most likely to suffer from medical conditions resulting from alcohol abuse, and contribute to a growing body of literature on health disparities that stem from socioeconomic factors. The researchers recommend that individuals with lower income or education levels might warrant additional screening by clinicians to evaluate their alcohol consumption and identify related conditions.
The authors add, “Among individuals with an alcohol use disorder, those with lower levels of education or lower incomes are at higher risk for developing an alcohol-related medical condition, such as cirrhosis or alcoholic cardiomyopathy. Additional screening and prevention efforts may be warranted to reduce health disparities.”

People who find themselves rummaging around in the refrigerator for a snack not long after they’ve eaten a filling meal might have overactive food-seeking neurons, not an overactive appetite.
UCLA psychologists have discovered a circuit in the brain of mice that makes them crave food and seek it out, even when they are not hungry. When stimulated, this cluster of cells propels mice to forage vigorously and to prefer fatty and pleasurable foods like chocolate over healthier foods like carrots.
People possess the same kinds of cells, and if confirmed in humans, the finding could offer new ways of understanding eating disorders.
The report, published in the journal Nature Communications, is the first to find cells dedicated to food-seeking in a part of the mouse brainstem usually associated with panic, but not with feeding.
“This region we’re studying is called the periaqueductal gray (PAG), and it is in the brainstem, which is very old in evolutionary history and because of that, it is functionally similar between humans and mice,” said corresponding author Avishek Adhikari, a UCLA associate professor of psychology. “Although our findings were a surprise, it makes sense that food-seeking would be rooted in such an ancient part of the brain, since foraging is something all animals need to do.”
Adhikari studies how fear and anxiety help animals assess risks and minimize exposure to threats, and his group made the discovery while trying to learn how this particular spot was involved in fear.
“Activation of the entire PAG region causes a dramatic panic response in both mice and humans. But when we selectively stimulated only this specific cluster of PAG neurons called vgat PAG cells, they did not alter fear, and instead caused foraging and feeding,” Adhikari said.

The researchers injected into mouse brains a virus genetically engineered to make the brain cells produce a light-sensitive protein. When a laser shines on the cells via a fiber-optic implant, the new protein translates that light to electrical neural activity in the cells. A miniature microscope, developed at UCLA and affixed to the mouse’s head, recorded the neural activity of cells.
When stimulated with laser light, the vgat PAG cells fired and kicked the mouse into hot pursuit of live crickets and non-prey food, even if it had just eaten a large meal. The stimulation also induced the mouse to follow moving objects that were not food — like ping pong balls, although it did not try to eat them — and it also prompted the mouse to confidently explore everything in its enclosure.
“The results suggest the following behavior is related more to wanting than to hunger,” Adhikari said. “Hunger is aversive, meaning that mice usually avoid feeling hungry if they can. But they seek out activation of these cells, suggesting that the circuit is not causing hunger. Instead, we think this circuit causes the craving of highly rewarding, high-caloric food. These cells can cause the mouse to eat more high-calorie foods even in the absence of hunger.”
Satiated mice with activated vgat PAG cells craved fatty foods so much, they were willing to endure foot shocks to get them, something full mice normally would not do. Conversely, when the researchers injected a virus engineered to produce a protein that dampens the cells’ activity under exposure to light, the mice foraged less, even if they were very hungry.
“Mice show compulsive eating in the presence of aversive direct consequences when this circuit is active, and don’t search for food even if they’re hungry when it’s not active. This circuit can circumvent the normal hunger pressures of how, what and when to eat,” said Fernando Reis, a UCLA postdoctoral researcher who did most of the experiments in the paper and came up with the idea to study compulsive eating. “We’re doing new experiments based on these findings and learning that these cells induce eating of fatty and sugary foods, but not of vegetables in mice, suggesting this circuit may increase eating of junk food.”
Like mice, humans also possess vgat PAG cells in the brainstem. It could be that if this circuit is overactive in a person, they might feel more rewarded by eating or crave food when not hungry. Conversely, if this circuit is not active enough, they could have less pleasure associated with eating, potentially contributing to anorexia. If found in humans, the food-seeking circuit could become the treatment target for some kinds of eating disorders.
The research was supported by the National Institute of Mental Health, the Brain & Behavior Research Foundation and the National Science Foundation.

A new study from researchers at the University of California, Davis, shows a ketogenic diet significantly delays the early stages of Alzheimer’s-related memory loss in mice. This early memory loss is comparable to mild cognitive impairment in humans that precedes full-blown Alzheimer’s disease. The study was published in the Nature Group journal Communications Biology.
The ketogenic diet is a low-carbohydrate, high fat and moderate protein diet, which shifts the body’s metabolism from using glucose as the main fuel source to burning fat and producing ketones for energy. UC Davis researchers previously found that mice lived 13% longer on ketogenic diets.
Slowing Alzheimer’s
The new study, which follows up on that research, found that the molecule beta-hydroxybutyrate, or BHB, plays a pivotal role in preventing early memory decline. It increases almost seven-fold on the ketogenic diet.
“The data support the idea that the ketogenic diet in general, and BHB specifically, delays mild cognitive impairment and it may delay full blown Alzheimer’s disease,” said co-corresponding author Gino Cortopassi, a biochemist and pharmacologist with the UC Davis School of Veterinary Medicine. “The data clearly don’t support the idea that this is eliminating Alzheimer’s disease entirely.”
Scientists gave mice enough BHB to simulate the benefits of being on the keto diet for seven months.
“We observed amazing abilities of BHB to improve the function of synapses, small structures that connect all nerve cells in the brain. When nerve cells are better connected, the memory problems in mild cognitive impairment are improved,” said co-corresponding author Izumi Maezawa, professor of pathology in the UC Davis School of Medicine.

Cortopassi noted that BHB is also available as a supplement for humans. He said a BHB supplement could likely support memory in mice, but that hasn’t yet been shown.
Other cognitive improvements
Researchers found that the ketogenic diet mice exhibited significant increases in the biochemical pathways related to memory formation. The keto diet also seemed to benefit females more than males and resulted in a higher levels of BHB in females.
“If these results translated to humans, that could be interesting since females, especially those bearing the ApoE4 gene variant, are at significantly higher risk for Alzheimer’s,” Cortopassi said.
The research team is optimistic about the potential impact on healthy aging and plans to delve further into the subject with future studies.
The study was funded by the National Institute on Aging, a unit of the National Institutes of Health.
Other authors include Jacopo Di Lucente and Lee-Way Jin with the Department of Pathology and the MIND Institute at UC Davis Health; John Ramsey, Zeyu Zhou, Jennifer Rutkowsky, Claire Montgomery and Alexi Tomilov with the School of Veterinary Medicine; Kyoungmi Kim with the Department of Public Health Sciences at UC Davis Health; Giuseppe Persico with the European Institute of Oncology, IRCCS; and Marco Giorgio with the University of Padova.

Astronauts have been able to track their muscle health in spaceflight for the first time using a handheld device, revealing which muscles are most at risk of weakening in low gravity conditions.
An international research team, including the University of Southampton and led by Charité University in Berlin, monitored the muscle health of twelve astronauts before, during and after a stay on the International Space Station (ISS).
Findings published in Nature Scientific Reportsindicate that the astronauts’ daily exercise regime was effective in preserving most muscle groups, but crucial lower leg muscles showed signs of deterioration.
The technology and assessment protocol used in space could also bring about a step-change in healthcare back on Earth, allowing healthcare professionals to better monitor muscle health in neuro-musculoskeletal conditions, such as Parkinson’s Disease and stroke, and in patients in critical care.
“Being able to perform inflight muscle health checks will allow the astronauts to see which muscles are losing strength and adjust their exercise programme accordingly,” says Professor Maria Stokes OBE, UK lead of the project, from the School of Health Sciences at the University of Southampton. “Being able to personalise exercises like this will be crucial on future long-duration missions to the Moon and Mars.”
Muscle loss in space
Microgravity conditions during spaceflight mean astronauts’ bodies aren’t subjected to the workload they are used to on Earth, meaning muscles don’t have to work very hard to perform functional tasks onboard the spacecraft. This puts astronauts at risk of muscle weakness and bone loss, with up to a 20 per cent decrease in skeletal muscle mass over a month.

To counteract this, astronauts onboard the ISS perform an exercise programme for around two hours a day, six or seven days a week. Until now, monitoring the effectiveness of this programme has only been possible with pre- and post-flight checks due to a lack of appropriate equipment.
Handheld device
The MyotonPRO is a smartphone-sized device which measures the properties of superficial skeletal muscles, tendons, ligaments, adipose tissue (fat), and skin. It’s non-invasive and uses a ‘tap and listen’ method, sending a precision impulse causing the tissues to oscillate and recording the way the tissue responds to compute various characteristics, such as stiffness, tone and elasticity.
The device was used to measure specific points on the astronauts’ bodies throughout their mission, before the flight, during a 4 to 11-month stay onboard the ISS, and up to three months post-flight. Researchers were particularly interested in measuring passive muscle stiffness, as it reflects muscle strength, which is not possible to measure in multiple muscles in space.
“People tend to associate stiffness with poor flexibility and mobility, but an adequate degree of passive stiffness is needed to maintain joint stability and posture,” says co-lead author Paul Muckelt, a research fellow at the University of Southampton. “Stiffness provides support during movement, preventing excessive stretching of muscles and reducing the risk of injury. It also contributes to the efficiency of movement by storing and releasing elastic energy during activities, such as walking or running.”
Passive muscle stiffness can shift throughout the day, so recording conditions needed to be standardised to ensure accuracy.

Weakening of crucial leg muscles
The team found that the astronauts’ exercise programme was effective in preserving muscle stiffness in most sites measured, including the shoulders, neck, back and thigh. But crucially, the tibialis anterior showed signs of waning in all 12 astronauts. The tibialis anterior, located in the front of the lower leg, lifts the foot upwards towards the shin. This movement is essential for walking and running.
The soleus and gastrocnemius muscles in the calf act in opposition to the tibialis anterior, pointing the foot downward. The soleus also showed a decrease in stiffness compared to preflight, but it did increase gradually over time on the ISS. The gastrocnemius increased in stiffness, indicating it might take over most of the function of the calf.
The Achilles tendon (attached to both muscles) also decreased in stiffness compared to preflight measurements. Monitoring the Achilles is important as sudden reloading, such as that induced by a change in gravitation force, could result in injury or even rupture.
Professor Dieter Blottner at the Charité -Universitätsmedizin Berlin, Germany, who led the Myotones Project said: “These lower leg muscles have a vital role in gait and ankle joint stabilisation. Impaired function could hinder performance on missions during planetary excursions and risk injury on return to Earth’s gravity, so exercises which target these muscles should be included in the astronauts’ exercise regimes going forward.”
Use on Earth
Measuring muscle health in this relatively simple way in space could translate to everyday life back on Earth — in healthcare settings, sports, remote communities and even people’s homes.
Assessing stiffness and other muscle characteristics helps in managing neurological disorders, like Parkinson’s disease and stroke. Currently, clinical assessments involve subjective methods, rating stiffness as mild, moderate or severe.
MyotonPRO offers objective measurements for a more accurate and sensitive assessment of the effects of different treatments. In the future, devices like this could be used by patients to monitor drug effects at home, akin to self-testing blood in diabetes.
Dr Martin Warner, co-senior author of the research paper from the University of Southampton said: “This technology and the use of passive muscle stiffness as a muscle health indicator could be used by many health professionals during clinical assessments. Widespread uptake could revolutionise healthcare in neuro-musculoskeletal, critical care and geriatric medicine, rehabilitation and precision medicine.”
Libby Moxon, Exploration Science Officer for Lunar and Microgravity at the UK Space Agency (UKSA), said: “As we approach increasingly ambitious missions that will see us travel deeper into space for longer, it’s imperative we fully understand how space travel impacts human muscle properties, so we can protect astronauts’ muscle health on long-duration missions.
“The University of Southampton’s fascinating research, supported by the UK Space Agency, demonstrates how innovative technology can support this goal, taking advantage of the microgravity environment to provide insights that will also help improve healthcare in space and back on Earth.”
Muscle stiffness indicating mission crew health in space is published in the Nature journal Scientific Reports and is available online.
The study was funded through the UK Space Agency (UKSA), the German Aerospace Agency (DLR), the European Space Agency (ESA) and the Science Technology Facilities Council (STFC).

Treating anxiety and depression reduced emergency room visits and rehospitalizations among people with heart disease, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.
“For patients who had been hospitalized for coronary artery disease or heart failure and who had diagnoses of anxiety or depression, treatment with psychotherapy, pharmacotherapy or a combination of the two was associated with as much as a 75% reduction in hospitalizations or emergency room visits. In some cases, there was a reduction in death,” said lead study author Philip Binkley, M.D., M.P.H., executive vice chair of the department of internal medicine and emeritus professor of internal medicine and public health at The Ohio State University in Columbus, Ohio.
Binkley noted that anxiety and depression are common in people with heart failure, and mental health can have a significant impact on an individual’s risk of other health conditions, disability and death.
In this study, Binkley and colleagues examined the association of mental health treatment with antidepressant medication or psychotherapy, also known as talk therapy or a combination of the two in relation to, emergency room visits, hospitalizations and death in people with blocked arteries or heart failure and with a formal diagnosis of anxiety or depression before hospitalization.
The analysis found using three different statistical models that adjusted for different variables and compared to patients not receiving treatment for anxiety or depression: For people who received both medication and talk therapy for anxiety or depression the risk of hospitalization was reduced by 68% to 75% the risk of being seen in the emergency department was reduced by 67% to 74%, and the risk of death from any cause was reduced by 65% to 67%. Psychotherapy treatment alone was associated with a 46% to 49% reduction of risk for hospital readmission and a 48% to 53% reduction in emergency room visits. Medication treatment alone reduced hospital readmission by 47% to 58% and reduced ER visits by 41% to 49%. Follow-up time was variable based on the needs of each patient.”Heart disease and anxiety/depression interact such that each promotes the other,” Binkley said. “There appear to be psychologic mechanisms that link heart disease with anxiety and depression that are currently under investigation. Both heart disease and anxiety/depression are associated with activation of the sympathetic nervous system. This is part of the so-called involuntary nervous system that increases heart rate, blood pressure and can also contribute to anxiety and depression.”
Binkley considers the large number of people with heart disease and the marked reduction in hospitalizations and emergency room visits and the drop in death to be the strength of the study.

“I hope the results of our study motivate cardiologists and health care professionals to screen routinely for depression and anxiety and demonstrate that collaborative care models are essential for the management of cardiovascular and mental health. I would also hope these findings inspire additional research regarding the mechanistic connections between mental health and heart disease,” he said.
Study details and background: 1,563 adults ages 22 to 64 over a three-year period were included, and all participants had a first hospital admission for blocked arteries or heart failure and had two or more health insurance claims for an anxiety disorder or depression. Sixty-eight percent of participants were women, and 81% were noted as white race. All were enrolled in Ohio’s Medicaid program during the six months prior to the hospital admission. Health data was from two sources: Ohio Medicaid claims and Ohio death certificate files from July 1, 2009, to June 30, 2012. Participants were followed through the end of 2014 or until death or the end of Medicaid enrollment. About 23% of participants received both antidepressant medications and psychotherapy; nearly 15 percent received psychotherapy alone; 29% took antidepressants alone; and 33% received no mental health treatment. About 92% of participants in the study were diagnosed with anxiety and 55.5% with depression prior to hospitalization.The study was limited to people enrolled in Medicaid, therefore, it may not be representative of people covered by commercial health insurance plans. In addition, the majority of participants were noted as white race, therefore, these finding are not applicable to people of other races, ethnicities or communities.
Co-authors, disclosures and funding sources are listed in the manuscript.

A mobile app that uses artificial intelligence, AI, to analyse images of suspected skin lesions can diagnose melanoma with very high precision. This is shown in a study led from Linköping University in Sweden where the app has been tested in primary care. The results have been published in the British Journal of Dermatology.
“Our study is the first in the world to test an AI-based mobile app for melanoma in primary care in this way. A great many studies have been done on previously collected images of skin lesions and those studies relatively agree that AI is good at distinguishing dangerous from harmless ones. We were quite surprised by the fact that no one had done a study on primary care patients,” says Magnus Falk, senior associate professor at the Department of Health, Medicine and Caring Sciences at Linköping University, specialist in general practice at Region Östergötland, who led the current study.
Melanoma can be difficult to differentiate from other skin changes, even for experienced physicians. However, it is important to detect melanoma as early as possible, as it is a serious type of skin cancer.
There is currently no established AI-based support for assessing skin lesions in Swedish healthcare.
“Primary care physicians encounter many skin lesions every day and with limited resources need to make decisions about treatment in cases of suspected skin melanoma. This often results in an abundance of referrals to specialists or the removal of skin lesions, which in the majority of cases turn out to be harmless. We wanted to see if the AI support tool in the app could perform better than primary care physicians when it comes to identifying pigmented skin lesions as dangerous or not, in comparison with the final diagnosis,” says Panos Papachristou, researcher affiliated with Karolinska Institutet and specialist in general practice, main author of the study and co-founder of the company that developed the app.
And the results are promising.
“First of all, the app missed no melanoma. This disease is so dangerous that it’s essential not to miss it. But it’s almost equally important that the AI decision support tool could acquit many suspected skin lesions and determine that they were harmless,” says Magnus Falk.

In the study, primary care physicians followed the usual procedure for diagnosing suspected skin tumours. If the physicians suspected melanoma, they either referred the patient to a dermatologist for diagnosis, or the skin lesion was cut away for tissue analysis and diagnosis.
Only after the physician decided how to handle the suspected melanoma did they use the AI-based app. This involves the physician taking a picture of the skin lesion with a mobile phone equipped with an enlargement lens called a dermatoscope. The app analyses the image and provides guidance on whether or not the skin lesion appears to be melanoma.
To find out how well the AI-based app worked as a decision support tool, the researchers compared the app’s response to the diagnoses made by the regular diagnostic procedure.
Of the more than 250 skin lesions examined, physicians found 11 melanomas and 10 precursors of cancer, known as in situ melanoma. The app found all the melanomas, and missed only one precursor. In cases where the app responded that a suspected lesion was not a melanoma, including in situ melanoma, there was a 99.5 percent probability that this was correct.
“It seems that this method could be useful. But in this study, physicians weren’t allowed to let their decision be influenced by the app’s response, so we don’t know what happens in practice if you use an AI-based decision support tool. So even if this is a very positive result, there is uncertainty and we need to continue to evaluate the usefulness of this tool with scientific studies,” says Magnus Falk.
The researchers now plan to proceed with a large follow-up primary care study in several countries, where use of the app as an active decision support tool will be compared to not using it at all.
The study was funded with support from Region Östergötland and the Analytic Imaging Diagnostics Arena, AIDA, in Linköping, which is funded by the strategic innovation programme Medtech4Health.

The public are being encouraged to eat more wild fish, such as mackerel, anchovies and herring, which are often used within farmed salmon feeds. These oily fish contain essential nutrients including calcium, B12 and omega-3 but some are lost from our diets when we just eat the salmon fillet.
Scientists found that farmed salmon production leads to an overall loss of essential dietary nutrients. They say that eating more wild ‘feed’ species directly could benefit our health while reducing aquaculture demand for finite marine resources.
Researchers analysed the flow of nutrients from the edible species of wild fish used as feed, to the farmed salmon they were fed to. They found a decrease in six out of nine nutrients in the salmon fillet — calcium, iodine, iron, omega-3, vitamin B12 and vitamin A, but increased levels of selenium and zinc.
Most wild ‘feed’ fish met dietary nutrient recommendations at smaller portion sizes than farmed Atlantic salmon, including omega-3 fatty acids which are known to reduce the risk of cardiovascular disease and stroke.
“What we’re seeing is that most species of wild fish used as feed have a similar or greater density and range of micronutrients than farmed salmon fillets,” said lead author, Dr David Willer, Zoology Department, University of Cambridge.
“Whilst still enjoying eating salmon and supporting sustainable growth in the sector, people should consider eating a greater and wider variety of wild fish species like sardines, mackerel and anchovies, to get more essential nutrients straight to their plate.”
In the UK, 71% of adults have insufficient vitamin D in winter, and teenage girls and women often have deficiencies of iodine, selenium and iron. Yet while, 24% of adults ate salmon weekly, only 5.4% ate mackerel, 1% anchovies and just 0.4% herring.

“Making a few small changes to our diet around the type of fish that we eat can go a long way to changing some of these deficiencies and increasing the health of both our population and planet,” said Willer.
The researchers found consuming one-third of current food-grade wild feed fish directly would be the most efficient way of maximising nutrients from the sea.
“Marine fisheries are important local and global food systems, but large catches are being diverted towards farm feeds. Prioritising nutritious seafood for people can help improve both diets and ocean sustainability,” said senior author Dr James Robinson, Lancaster University.
This approach could help address global nutrient deficiencies say the team of scientists from the University of Cambridge, Lancaster University, University of Stirling and the University of Aberdeen.
The study was published today in the journal Nature Food.
The scientists calculated the balance of nutrients in edible portions of whole wild fish, used within pelleted salmon feed in Norway, compared to the farmed salmon fillets.

They focused on nine nutrients that are essential in human diets and concentrated in seafood — iodine, calcium, iron, vitamin B12, vitamin A, omega-3 (EPA + DHA), vitamin D, zinc and selenium.
The wild fish studied included Pacific and Peruvian anchoveta, and Atlantic herring, mackerel, sprat and blue whiting — which are all marketed and consumed as seafood.
They found that these six feed species contained a greater, or similar, concentration of nutrients as the farmed salmon fillets. Quantities of calcium were over five times higher in wild feed fish fillets than salmon fillets, iodine was four times higher, and iron, omega-3, vitamin B12, and vitamin A were over 1.5 times higher.
Wild feed species and salmon had comparable quantities of vitamin D.
Zinc and selenium were found to be higher in salmon than the wild feed species — the researchers say these extra quantities are due to other salmon feed ingredients and are a real mark of progress in the salmon sector.
“Farmed salmon is an excellent source of nutrition, and is one of the best converters of feed of any farmed animal, but for the industry to grow it needs to become better at retaining key nutrients that it is fed. This can be done through more strategic use of feed ingredients, including from fishery by-products and sustainably-sourced, industrial-grade fish such as sand eels,” said Dr Richard Newton of the Institute of Aquaculture, University of Stirling, whose team also included Professor Dave Little, Dr Wesley Malcorps and Björn Kok.
“It was interesting to see that we’re effectively wasting around 80% of the calcium and iodine from the feed fish — especially when we consider that women and teenage girls are often not getting enough of these nutrients.”
Willer said “These numbers have been underacknowledged by the aquaculture industry’s standard model of quoting Fish In Fish Out (FIFO) ratios rather than looking at nutrients.
The researchers would like to see a nutrient retention metric adopted by the fishing and aquaculture industries. They believe that if combined with the current FIFO ratio, the industry could become more efficient, and reduce the burden on fish stocks that also provide seafood. The team are building a standardised and robust vehicle for integrating the nutrient retention metric into industry practice.
“We’d like to see the industry expand but not at a cost to our oceans,” said Willer.
“We’d also like to see a greater variety of affordable, convenient and appealing products made of wild ‘feed’ fish and fish and salmon by-products for direct human consumption.”
The research was funded by the Scottish Government’s Rural and Environmental Science and Analytical Services Division (RESAS), a Royal Society University Research Fellowship, a Leverhulme Trust Early Career Fellowship a Henslow Fellowship at Murray Edwards College and the University of Cambridge.

Getting dementia diagnosed can be a long and difficult process for anyone, but some may face additional challenges based on race or ethnicity and where they live, according to a study led by Washington State University researchers.
The study of nearly 95,000 Washington state residents found that people living outside of urban areas as well as Native American and Hispanic people face longer travel distances to be seen by neurologists. The researchers said these disparities could be contributing to delayed diagnoses, which can result in higher costs of care, reduced chances of preserving cognitive function and lower quality of life for dementia patients.
“We are facing an increasing demand for physicians who can meet the needs of people with Alzheimer’s disease or related dementias as the number of people diagnosed is rising,” said lead study author Solmaz Amiri, a researcher in the WSU Elson S. Floyd College of Medicine and the Institute for Research and Education to Advance Community Health (IREACH). “Given this added burden of access in rural and minoritized populations, we need to better understand the barriers people face in accessing care so we can help them achieve better dementia outcomes.”
Published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, Amiri and her coauthors analyzed 2011-2021 Washington state death records for people who were identified as having Alzheimer’s disease or related dementias. Calculating the distance from each person’s home to the closest neurologist, the researchers showed that people in urban areas lived an average of 9 miles from a neurologist. That distance increased to 45 miles for residents of suburban areas, 88 miles for residents of small towns and 100 miles for rural residents. They also saw disparities when comparing travel distances by race and ethnicity, finding that Native American and Hispanic people had to travel around 28 and 22 miles respectively to reach a neurologist, versus between 7 and 17 miles for other racial groups.
“As dementia progresses, the need for people to access a physician increases. To these people, even 17 miles is a large distance that presents a significant burden, so you can imagine how hard it would be to have to travel 100 miles to see a neurologist,” Amiri said.
She said the researchers’ findings could help inform the placement of future medical resources such as neurology practices, residency programs and medical student rotations. Strategically placing these inside so-called hot spots — clusters of areas identified in the study as having significantly longer driving distances — could help reduce disparities in dementia outcomes.
Other potential solutions include offering people living in rural areas care via telemedicine or through mobile health care units. Better preparing rural primary care physicians to diagnose and care for people with dementia is also essential, Amiri said. A recent Alzheimer’s Association survey of primary care physicians showed that although more than 80% reported providing dementia care, most had received little or no training in that area and many were not confident in their care for patients with Alzheimer’s and other dementias.
Amiri noted that other factors that limit provider access could not be examined in this study since data on these were not readily available. For example, people may not have insurance, their insurance plan may not be accepted by certain providers and there may be long waits for appointments.
Cultural differences among racial groups may play a role as well. The study showed that Black people live closer to neurologists than other racial groups, yet previous research has shown that they experience large disparities in dementia diagnosis and outcomes. Given that Black people have historically been subjected to racism, healthcare segregation and secret experimentation, one possible explanation may be that they are less likely to seek out neurology care due to an inherent mistrust of white-dominated healthcare settings.
The researchers are planning additional research to better understand how dementia outcomes may be impacted by various factors, including a recently funded study that will relate cognitive outcomes in Native Americans to physician access and neighborhood characteristics.

For most people, recovering from an injury or surgery might require a short round of painkillers, but for about one in 10 people, pain can trigger protracted and escalating mental, physical and behavioral health problems.
Identifying who is at risk of poor pain outcomes could help steer patients to early interventions that set them on a better course while also reducing the potential for opioid overuse.
Now, a simple way to spot those at risk could be as simple as a two-question survey. In a study among patients at the Duke Integrated Pain and Wellness Program, researchers found that a carefully worded, short questionnaire successfully identified people who were most likely to develop chronic pain. These patients were then steered to a more detailed risk stratification and holistic services that led to better outcomes.
Findings appear March 20 in the New England Journal of Medicine Catalyst.
“Unlike traditional methods that reactively address chronic pain, this approach proactively provides resources to prevent the development of high-impact chronic pain, ensuring the right patient gets the right resources at the right time — before the problem escalates,” said senior author Padma Gulur, M.D., professor in the departments of Anesthesiology and Population Health Sciences at Duke University School of Medicine.
Gulur and colleagues enrolled patients who were referred to Duke’s pain and wellness program. Patients were given a two-questions survey that was developed after reviewing studies that identified factors leading to poor pain outcomes: Have you ever felt your pain is terrible and it’s never going to get any better? (Y/N) Have you ever used an illegal drug or prescription medication for non-medical reasons? (Y/N)More than 13,500 patients — about 12% — responded yes to both questions and were considered at high risk of poor pain outcomes.

They further stratified participants into high, medium and low risk categories, with those at highest risk offered personalized treatment plans based on their level of need. The range of holistic interventions included close pain management with a pain specialist, referrals to social services for food, housing or transportation needs, and access to behavioral health, physical therapy and nutrition programs.
“The interventions were tailored to meet patients at their current state of pain management and to motivate them toward adopting a more holistic approach,” Gulur said. “The guiding principles emphasize that patients are doing as well as they can with the coping skills they have but, with the right support, they can do better.”
Of the 432 patients at highest risk of poor pain outcomes who participated in the holistic treatment approach, 224 patients (51%) reduced their morphine dose within 30 days.
The number of patients who reduced their morphine dose rose to 299 patients at 60 days and to 349 patients at 180 days. The program’s effects were much better than those achieved through other chronic pain management approaches.
“By demonstrating the effectiveness of early identification and intervention for patients at risk of poor pain outcomes, this research can inform the development of new therapies and treatment approaches focused on prevention,” Gulur said. “It could lead to improved health services by integrating similar proactive care models into broader health care settings, enhancing scientific understanding and leading to better health care outcomes through more personalized and preemptive pain management strategies.”
In addition to Gulur, study authors include Nathan Christie, Amy Pope, Diana Zambrano, Kevin Vorenkamp, and Amanda Nelli.
The study was funded by Duke Health.