Infant Formula Claims; COVID Reinfection Protection

TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.

This week’s topics include protection from COVID from infection, a new treatment for Parkinson’s disease, consumption of fruits, vegetables and sugar-sweetened beverages among young children, and claims of infant formula manufacturers.

0:35 Reinfection protection from COVID infection

1:35 Infection just as infection as current vaccine

2:35 Durable immunity to other viruses

3:00 New treatment for Parkinson’s disease

4:00 Enrolled 90+ patients

5:00 Heat a part of the brain

6:00 Don’t address how patients feel

6:12 Health and nutrition claims for infant formula

7:12 Scientific evidence?

8:18 Where people can least afford it

9:12 Fruit, vegetable and sugar-sweetened beverage intake

10:14 States that have other health issues

11:14 Increases risk of obesity and diabetes

12:15 End

Transcript:

Elizabeth: Kids and fruit, vegetable, and sugar-sweetened beverage consumption.

Rick: Does past COVID infection protect against reinfection?

Elizabeth: A new treatment for Parkinson’s disease.

Rick: And are the health and nutrition claims of infant formulas correct or incorrect?

Elizabeth: That’s what we’re talking about this week on TTHealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.

Rick: And I’m Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I’m also dean of the Paul L. Foster School of Medicine.

Elizabeth: Rick, of course, we’re going to start with our COVID material. That’s in the Lancet.

Rick: Despite vaccination, many people get infections. The real question is once you’ve had a COVID infection, does that prevent reinfection?

What these authors did was they did a systematic review and meta-analysis looking at 65 different studies from 19 different countries. They looked at all the different variants of COVID — the original ones, but also the newer Omicron variant. Here is what they discovered.

If an individual was infected with COVID, over the subsequent year there was about a 75% to 80% reduced rate of reinfection. That’s about the same efficacy as it is with vaccines that we’re using. However, it was a little bit less effective protecting against the Omicron, about 45% to 50%. But here is really the important thing is that regardless of what variant you had, an infection protected you about 90% from having a very serious COVID infection, including hospitalization or death, regardless of what the variant was. This suggests that infection, although we don’t advocate for it, is just as effective as our current vaccines in preventing reinfection.

Elizabeth: That’s a whole lot, like glass half-full, glass half-empty so that if one becomes infected with COVID the notion that that’s protective feels good. What about vaccination in that scheme?

Rick: A couple of things. In many countries — for example, the U.S. and Australia — when we’re having people moving in and out during travelling times, we demanded that people have proof of vaccination. Other places in Europe said, listen, you don’t need just vaccination. If you’ve actually been infected, that’s just as good. It wasn’t just effective immediately, but even as long as 40 weeks it was just as protective.

That suggests to me that we need to re-look at our vaccines and what we’re demanding of individuals. The second thing is, it really behooves us to look at the variants and how infection will protect — or not protect — in subsequent variants as well.

Elizabeth: One of my questions about this — and, of course, it’s a science question — is what is it about this virus that makes it so wily in terms of durable immunity? Certainly, we are confronted with viruses all the time and many of them we do have very robust immunity against.

Rick: Immunity typically wanes, whether with this virus or any other virus. The development of variants has made it a little bit more wily, a little bit more elusive. It’s interesting because once you’ve had an Omicron infection, it protects against subsequent Omicron infections and even the variants of it as well.

Elizabeth: Let’s turn to the New England Journal of Medicine. I said a new treatment for Parkinson’s disease. Parkinson’s disease, of course, is a movement disorder extremely troubling for many people. For a long time, for people who have had a tremor that really is very difficult to manage, there have been implantable devices that help ameliorate some of the impact of that.

It turns out that there are a lot of people who are very resistant to getting those devices, and I guess I can understand that. I’m not sure I would want a bunch of electrodes and so forth implanted in my brain either. Also, some people don’t live in areas — those devices have to be updated pretty often and people don’t live in proximity to a place that’s capable of doing that.

And so this is another strategy that’s being used to treat this very troubling tremor that many people with Parkinson’s disease have. It involves ablation of the internal segment of the part of the brain called the globus pallidus on the opposite side of where the symptoms are most severe.

They enrolled in this study 94 patients, 69 of whom were assigned to undergo this ablation using ultrasound and 25 who had a sham procedure. In their active treatment group, 69% of them had a response as compared to only 32% in the control group. Thirty-nine patients in the active treatment group who had a response at 3 months and also who were assessed at 12 months; 30 of those continued to have a response.

It seems like it’s fairly durable. Adverse events relative to their active treatment group included dysarthria, gait disturbance, loss of taste, visual disturbance, and facial weakness. That sounds a little more dire than the actual numbers bear out. It seems like it may be another part of the armamentarium in terms of trying to manage these troubling motor defects that are seen in Parkinson’s disease.

Rick: Elizabeth, as you say, it’s an alternative to doing ablation, which is pretty much you heat a part of the brain to kill a part of the brain to see if you can make the movement disorders better. The downside of that is, it’s not reversible. With the implantable electrodes, you can stimulate. You turn that up or down. You can modulate that. But this, once it’s done it’s done.

As you mentioned, about 70% of people have initial response. Of those, about three-fourths have continued response. It’s not really quite as good as the electrical stimulation therapy, but it does provide an alternative.

Elizabeth: Yeah. I guess for those people who really don’t want something implanted in their brain it may be a reasonable alternative. I would also note that when I reflect on having this treatment it kind of makes me a little squeamish. The patients were awake and they were also off their medications. That must have been a pretty tough thing.

They have to aim to reach a target temperature in this part of the globus pallidus of 55 degrees C so that’s pretty hot. I just wonder about sort of some of the experience of having this particular treatment employed.

Rick: Yeah. Again, they don’t address how the patients feel during this time. They do address some of the side effects. But as you said, this is done in an MRI magnet so they can monitor the temperature. Often times these crude methods end up being more refined and we get better at it. I’m hoping that’s what will happen here.

Elizabeth: Let’s turn now to the BMJ issue of international import and that’s health and nutrition claims for infant formula.

Rick: Make no doubt about it. For infants, human breast milk is the optimal source of infant nutrition. They are at obviously a growing age and they are developing their immune system. They are developing their neurologic system and their motor system, and trying to avoid infections, and human breast milk is the best way to feed infants.

Sometimes that’s really not possible. Oftentimes, however, it’s a choice by the mother. It’s a choice of convenience. If you decide to use infant formula instead of breast milk, you’re trading off some of the benefits of breast milk.

Unfortunately, what happens is the infant formula manufacturers oftentimes make claims about their formula: it boosts the immune system or advances neurologic function and development of the child. It provides necessary vitamins for their growth and their development just as good as human breast milk.

There are a bunch of claims. and what these authors sought to do was say, “OK, let’s look at the claims and see if they’re valid or not. Is there scientific evidence behind them?”

This is an international study of 15 different countries. What they found out is that most of the products carried at least one claim. By the way, there was a wide range of different claims even though it was the same ingredient. There were also multiple classes of ingredients for the same claim, when in fact when they looked at scientific evidence there was very little scientific evidence at all, and most of it were considered to be high-bias studies i.e. studies that were funded by the food company and/or by investigators that receive money from them. Most of the claims really aren’t valid, which is a general concern, as you said, worldwide.

Elizabeth: This is very, very troubling to me because as we know, when manufacturers go into countries and advertise all of these things as “It’s more convenient,” “It’s just as good as breast milk” or is better than breast milk in fact in terms of neurologic development, or what have you, it really reduces the rates of breastfeeding in those places. It seems like — and I don’t know if there is any data in this study — that it’s those places that can least afford to have this happen where mothers adopt this practice of employing formula versus breast milk.

Rick: It’s interesting because they looked at the different countries — low-, middle-, and high-income countries — and the claims were made regardless; they were ubiquitous. I don’t think our listeners would appreciate it — and I didn’t until I read this article — that suboptimal breastfeeding is estimated to result in about 600,000 child deaths from pneumonia and diarrhea each year. Furthermore, when women don’t breastfeed, it increases their risk of developing ovarian and breast cancer. The excess deaths from that is about 100,000 per year as well.

Elizabeth: Can infant formula manufacturers be forced not to make these kinds of claims relative to their products?

Rick: Well, in fact, there are two things. There are mandatory information requirements, but they are not being enforced. That enforcement really needs to take place.

Elizabeth: Well, speaking of things here in the U.S. and also of children, let’s turn to Morbidity and Mortality Weekly Report (MMWR) and take a look at fruit, vegetable, and sugar-sweetened beverage intake among young children — those 1 to 5 years of age. This is, of course, a national survey of children’s health and they have 18,000+ folks who are represented in this particular assessment.

They were looking, as I said, at the consumption of fruits, vegetables, and sugar-sweetened beverages nationally and by state. They inquired of parents about the preceding week. One in three, approximately, children did not eat a daily fruit in the previous week. Nearly one half did not eat a daily vegetable. More than one half, almost 60% in fact, drank a sugar-sweetened beverage at least once.

Then our same old geographic regions of the country that we finger all the time relative to cigarette smoking and obesity are also represented well here. There was considerable variability around the country. For example, the consumption of a sugar-sweetened beverage in the preceding week was about 40% in Maine and almost 80% in Mississippi. It’s looking like there are lots of places where intervention is important.

Rick: Elizabeth, you mentioned the regional variation, kind of states particularly in the Southeast — we’re talking about Georgia, Mississippi, Louisiana, Arkansas, and even Oklahoma — had some of the lowest rates of intake of both vegetables and fruits among kids. Aside from the geographic variation, you won’t be surprised to know that Black children had a lower incidence of eating healthy, and also kids that had marginal or low food sufficiency. They were not only less likely to have fruits or vegetables, but more likely to consume sweetened beverages as well.

Where the rubber hits the road here is that we know that fruits and vegetables are important for the development of the child. Excessive amount of sugar-sweetened beverages increases the risk of diabetes and obesity, even cavities as well. We need to do a better job of providing these foods through federal and state programs, mandating things at school as well to make sure things are healthy, and do a better job of educating.

Elizabeth: Unquestionably, those are all things that need to be done. In fact, you are aware, I know, of last week the federal government made an announcement relative to school lunches and in trying to really change the nutritional content of those to help to promote some of these objectives.

Rick: Elizabeth, unfortunately the population that you’re talking about in this particular study were the kids that haven’t even made it to school yet.

Elizabeth: Definitely we need strategies at all kinds of levels to help overcome this problem. On that note then, that’s a look at this week’s medical headlines from Texas Tech. I’m Elizabeth Tracey.

Rick: And I’m Rick Lange. Y’all listen up and make healthy choices.