Susan Kreimer

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A new study led by a researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore suggests that people who vape may be increasing their risk of developing prediabetes, even if they don’t smoke conventional cigarettes.

The data on 600,000 U.S. adults showed that those who inhaled the chemicals in e-cigarettes were more likely to have prediabetes than those who hadn’t engaged in vaping or smoking behaviors.

With e-cigarette use on the rise among youth and young adults, health experts are sounding alarm bells about the potential dangers.

“There is a perception among the younger population that e-cigarettes are a safer alternative,” says 

, Ph.D., a professor of environmental health sciences at Johns Hopkins and co-author of the study published in the 

 “More data is piling up that e-cigarettes are not harmless as they were originally perceived by the users. They do contain many chemicals which have toxic effects.”

Results of the federal government’s 2021 National Youth Tobacco Survey showed that 13.4% (2.06 million ) of high school students and 4% (470,000) of middle schools were current users of a tobacco product and that that e-cigarettes were the most commonly used products. The survey results, 

indicate that 1.72 million high school students use e-cigarettes and 320,000 middle schoolers.

In addition to an elevated risk of prediabetes, lung and heart diseases are major concerns that stem from vaping and smoking, says Biswal, adding that research has linked vaping to erectile dysfunction.

“This study is a good first look at the impacts of vaping and chronic disease development,” says Farah Naz Khan, M.D., a clinical assistant professor in the division of metabolism, endocrinology and nutrition at the University of Washington School of Medicine in Seattle. “More research will be needed to better understand correlation versus causation.” But it is plausible that vaping can affect the development of prediabetes, particularly if a person has other risk factors such as family history, obesity and insulin resistance, Khan says.

Previously, the Surgeon General concluded that cigarette smoking can contribute to the onset of Type 2 diabetes, says Brenna VanFrank, M.D., MSPH, senior medical officer at the CDC’s Office on Smoking and Health.

“Evidence is well established regarding the link between cigarette smoking and inflammation,” VanFrank says. “Cigarette smoke-induced inflammation is a contributing mechanism to a variety of diseases caused by smoking, including cancer, lung disease and cardiovascular disease.”

Cigarette smoking can create low-grade inflammation throughout the body by attacking white blood cells, which protect against invaders and respond to injury. It damages them by activating the release of chemical substances that circulate and localize in tissues, says David C. Christiani, M.D., M.P.H., M.S., a professor at the Harvard T.H. Chan School of Public Health and Harvard Medical School in Boston.

“Animal data and some preliminary human data indicate that vaping can activate some of the same pathways as combustibles, says Christiani, who is also a pulmonologist at Massachusetts General Hospital.

It is still unknown whether prediabetes will develop into full-blown diabetes if a person continues to vape. “This study cannot answer that definitively,” he says.

“However, prediabetes as a condition is linked with adverse health outcomes such as those seen with full-blown diabetes: heart disease, stroke, peripheral vascular disease. So, persistent use will lead to persistent prediabetes, and an elevated risk of these conditions.”

The good news is that quitting smoking decreases markers of inflammation, according to the 2020 Surgeon General’s Report on Smoking Cessation. Yet VanFrank notes that “airway inflammation may persist for months to years after quitting.”

Khan adds that “the best way to try to prevent further inflammation is to stop the offending factor, whether that is smoking or vaping. This can prevent further inflammation from developing, but it is unlikely to reverse any damage that has already occurred.”

Still, Biswal says prediabetes is reversible with lifestyle management. He recommends “doubling down on public health measures to prevent the initiation and use of e-cigarettes, at least among youth.”

Articles

A Johns Hopkins study found an association between use of e-cigarettes and  prediabetes. More research is needed to tease out the possible causal elements of the association. Meanwhile, a federal government survey found that 1.72 million high school students and 320,000 middle schoolers are current users of e-cigarettes.

Study Links Vaping and Prediabetes

Many individuals with multiple sclerosis (MS) may have weak bones that predispose them to fractures, suggesting that bone health monitoring is important for people with this disease of the central nervous system, a new meta-analysis has shown.

Osteopenia — the medical term for bone mineral density that is lower than normal — affected 43% of MS patients included in the meta-analysis, which included 29 studies, six conference papers and almost 14,000 study subjects.

The meta-analysis also found that about 17% of MS patients have osteoporosis, which is characterized by lower bone density that osteopenia, so bones are even more fragile and susceptible to fracture.

The prevalence of osteoporosis/osteopenia in patients with multiple sclerosis (MS): a systematic review and meta-analysis

“It’s helpful for clinicians to have a systematic review and meta-analysis demonstrating the prevalence of osteopenia and osteoporosis in the MS population,” says Julie Fiol, M.S.W., BSN, RN, MSCN, associate vice president of healthcare access at the National Multiple Sclerosis Society. “Hopefully, this helps raise awareness of the need for appropriate screening.”

Researcher have identified several factors that may make MS patients prone to developing osteopenia and osteoporosiss: prolonged, MS-related motor disability that diminishes mechanical loading of bone, vitamin D deficiency and the use of corticosteroids to treat MS relapses.

“Mobility impairment is a risk factor for decreased bone density, and it is also a risk factor for falls,” notes Fiol. “If someone with decreased bone density falls, they are more prone to bone fractures, which leads to further impaired mobility and other complications. “People with MS, even those with mobility impairment, should be encouraged to exercise regularly, particularly to engage in weight-bearing exercise, she adds.

Lead author Mohaddeseh Azadvari of the Department of Physical Medicine and Rehabilitation at Imam Khomeini Hospital in Tehran, Iran, sifted through studies published up to March 2021. The research included in the meta-analysis was published between 2004 and 2020.

Azadvari and his colleagues said that additional research would be necessary to further elucidate the occurrence of osteoporosis and osteopenia in MS patients. Res

Other research has drawn a connection between MS and vitamin D deficiency. A link between MS and low vitamin D levels would fit with the fact that MS is more common in northern latitudes. Vitamin D production relies on skin exposure to sunlight, so people residing farther away from the equator are at higher risk of deficiency.

Fiol recommends that clinicians measure vitamin D level with a blood test and recommend supplementation when appropriate. A bone density scan also can be performed, especially for those with risk factors, such as mobility impairment and frequent corticosteroid use.

Beyond that, “people should ensure they are getting adequate calcium intake in their diet or supplement if needed,” she says. “Limiting alcohol intake and smoking cessation can also improve bone health.”


A recent meta-analysis shows that a large proportion of people with multiple sclerosis have osteopenia or osteoarthritis. Lack of mobility and vitamin D deficiencies may play a causative role.

Fractures Should Be Concerning to Clinicians Caring for Patients With MS

Since its inception, magnetic resonance imaging (MRI) has been lauded for its ultra-sensitivity in identifying plaques in the brain and spine of patients with multiple sclerosis (MS). In the years since, it has become vital for diagnosing MS, in addition to gauging response to treatment or disease progression.

But despite the capabilities of standard MRI — equipped with conventional 1.5-, or 3-tesla (T) magnetic field strength — the technology isn't sensitive enough to detect all the components of this neurodegenerative disease in which the body's immune system attacks the fatty protective myelin sheath surrounding nerve fibers.

Now, a new study published online Jan. 4 in the journal 

 found that high-resolution MRI of neurochemicals termed MR spectroscopic imaging  at 7.0 T can help visualize pathologic findings beyond the lesions in participants with multiple sclerosis. It detected MS-relevant neurochemical changes in the normal-appearing white matter and cortical gray matter of the brain that were associated with patients' disability.

The research was led by Eva Heckova, Ph.D., a postdoctoral researcher in the High Field MRCentre at the Medical University of Vienna in Austria.

"If the results are confirmed in further clinical longitudinal studies, MR spectroscopic imaging could become a standard imaging tool for initial diagnosis, for disease progression and therapy monitoring," Heckova says.

MR spectropic imaging allows for assessment of brain metabolism and is of keen interest in MS, where MRI showing merely structure cannot adequately shed light on microscopic components of disease activity.

The study recruited 65 participants with MS and 20 age- and sex-matched healthy controls, with an average age of 32, between January 2016 and December 2017. Metabolic ratios were obtained in white matter lesions, normal-appearing white matter and cortical gray matter regions.

MR spectroscopic imaging at 7.0 T permitted visualization of brain metabolic alterations, particularly those related to neuroinflammation, which cannot be visible with conventional T1- or T2-weighted MRI.

“Seven-tesla MR spectroscopy offers improved signal-to-noise ratios and improved spectral resolution compared with lower field strengths, such as 3.0 and 1.5T,” Peter B. Barker, D.Phil., professor of radiology and oncology at the Johns Hopkins University School of Medicine in Baltimore, wrote in an editorial accompanying the trial’s results.  “As a result, more compounds can be detected with higher accuracy. However, before these improvements can be realized in practice, many engineering challenges have to be overcome ...”

The National Multiple Sclerosis Society expressed optimism that this trial could pave the way toward better diagnostic tools. "We find this research finding to be intriguing and encourage the research team to continue to explore the utility of this approach in the diagnosis of MS,” says Julie Fiol, the society's associate vice president for healthcare access.

New technology detects changes in the brain beyond the lesions seen with normal MRI scans.

Study: High-resolution MRI Permits Visualization of Metabolic Change in the Brain  Related to Inflammation in MS Patients

 may be the main cause of multiple sclerosis (MS), a progressive and incurable neurological disease afflicting 2.8 million people worldwide, a new study reveals.

Results of the study — led by researchers at the Harvard T.H. Chan School of Public Health — were published online in

To explore the potential link between EBV and MS, the Harvard researchers evaluated more than 10 million young adults on active duty in the U.S. military, measuring EBV antibodies in blood serum samples stored by the Department of Defense. They identified 955 service members diagnosed with MS. Those infected with EBV after joining the military had a heightened risk of developing MS compared to those who did not contract the virus.

As a chronic inflammatory disease of the central nervous system, MS wreaks havoc on the myelin sheaths, insulating layers of fatty tissue that safeguard neurons in the brain and spinal cord. EBV is a herpes virus that triggers infectious mononucleosis and continues to lurk inside the body for life. The exact mechanism by which it could cause MS remains unclear. 

Substantiating EBV’s causal role in MS has been fraught with challenges, partly because EBV infections are so common. About 95% of adults get infected with the virus, yet only a tiny fraction of people ever develops MS. Moreover, the onset of MS symptoms occurs, on average, a decade after EBV infection, and some studies have found that MS develops 30 years after the EBV caused mononucleosis, says 

, Sc.D., a senior research scientist at Harvard public health school and one of the study’s two senior co-authors.

“We can consider EBV necessary to developing MS, but there need to be other mitigating factors, such as a genetic predisposition,” says Munger. Cigarette smoking, vitamin D deficiency and obesity, particularly early in life, could play a role in whether EBV infection leads to MS.

The researchers suspect that that the time lag between EBV infection and MS onset could stem, in part, from the MS symptoms not occurring during the initial pathophysiology. Another factor may be that the relationship between viral infection and the immune system may evolve, with the latent infection reactivating due to persistent stimulation.

There are antiviral medications that can help control infection, but no drugs for MS that specifically target EBV. The researchers expressed hope for development of an EBV vaccine or EBV-specific antiviral drugs — and an EBV vaccine may be in the works. In early January, Moderna launched early-stage clinical trials in humans to test an mRNA vaccine against the EBV virus. The company expects to assess the vaccine’s safety and dosage in about 270 participants.

“Moderna is committed to developing a portfolio of first-in-class vaccines against latent viruses for which there are no approved vaccines today,” Stéphane Bancel, the company’s chief executive officer, said in a prepared statement.

If the trial shows that the experimental vaccine is safe and has some efficacy, the same mRNA technology underpinning Moderna’s COVID-19 vaccine could be applied to develop to EBV vaccine.

“A vaccine against EBV may result in the prevention of the majority of MS cases,” Munger says.

A longitudinal study of 10 million people in the U.S. military shows the link. The researchers say genetic predisposition, other factors are likely needed for the viral infection to cause multiple sclerosis.

Susan Kreimer

Articles

Study Links Vaping and Prediabetes

Fractures Should Be Concerning to Clinicians Caring for Patients With MS

Study: High-resolution MRI Permits Visualization of Metabolic Change in the Brain Related to Inflammation in MS Patients

Harvard Researchers Identify Epstein-Barr Virus as a Cause of MS