Ding D, Van Buskirk J, Nguyen B Physical activity, diet quality and all-cause cardiovascular disease and cancer mortality: a prospective study of 346 627 UK Biobank participants. Br J Sports Med. 2022; 0:1-10

Inoue A, Hiratsuka Y, Takesue A, Aida J, Kondo K, Murakami A Association between visual status and the frequency of laughter in older Japanese individuals: the JAGES cross-sectional study. BMJ Open Ophthalmol. 2022; 7

Effect of foot reflexology massage on pain and pain anxiety severity during dressing change in burn patients. 2022.

Volk BM, Roberts CGP, Van Tieghem M Reduced COVID-19 severity elicited by weight loss from a medically supervised ketogenic diet in a geographically diverse ambulatory population with type 2 diabetes and obesity. BMJ Nutr Prev Health. 2022; 0

Research Roundup

02 September 2022
3 min read
Volume 33 · Issue 9


George Winter provides an overview of recently published articles that may be of interest to practice nurses. Should you wish to look at any of the papers in more detail, a full reference is provided.

Exercise cannot fully compensate for a poor quality diet

Although regular exercise and a healthy diet are central to the prevention of several chronic diseases, there is debate over whether one can ‘outrun a bad diet’ through high levels of physical activity.

Ding et al (2022) hypothesised that exercise and diet quality are independently associated with lower mortality risk, and that high levels of physical activity cannot offset the detrimental effects of a poor-quality diet. To test this, they investigated 346 627 adults using UK Biobank data linked to NHS death records, examining independent and joint associations of diet and exercise with all-cause, cardiovascular disease (CVD) and cancer mortality.

During a median follow-up of 11.2 years, 13 869 participants died from all causes, 2650 from CVD and 4522 from adipose-related cancers. Results showed that the combinations with the lowest mortality risk consistently included high-quality diet scores and higher exercise levels, but high levels of exercise did not compensate for the detrimental effects of a poor diet on mortality risk.

The authors reject ‘the myth about “exercise outrunning a bad diet". Our study provided important evidence for health professionals that exercise does not fully compensate for a poor diet and that we should recommend and advocate for both an active lifestyle and a healthy diet.’

Study shows ketogenic diet may reduce COVID-19 hospitalisation rates in those with type 2 diabetes

Type 2 diabetes mellitus (T2DM) and obesity are risk factors for severe COVID-19 infection and death. A retrospective inpatient hospital study suggested that a ketogenic diet showed promise in reducing the severity and risk of death from COVID-19, but the impact of a ketogenic diet and its clinical effects on COVID-19 severity in an ambulatory population were unknown.

In this American outpatient telemedicine-based study, Volk et al (2022) investigated factors associated with COVID-19 severity in ambulatory individuals living in geographically diverse areas with T2DM and obesity treated with a medically supervised ketogenic diet (MSKD). The authors assessed outcomes among 339 individuals who received a COVID-19 diagnosis after starting a MSKD and responded to the survey, plus one individual with a known COVID-19-related death.

The study showed that among this outpatient population with T2DM and obesity, only 11% of patients who reported a COVID-19 diagnosis needed hospitalisation; fewer were treated with supplemental oxygen and ventilation, and only one death (0.3% of diagnosed) due to COVID-19 occurred. For comparison, a regional medical system reported COVID-19 hospitalisation and death rates of 44% and 5%, respectively, among non-MSKD ambulatory patients with T2DM.

This study's results ‘demonstrate that therapies such as MSKD, which elicit rapid, significant weight loss, may favourably impact hospitalisation rate and severity of COVID-19 in patients with T2DM.’

Improved vision may increase laughter

Humour and laughter have played an important role in human culture since the beginning of recorded time, and they confer well-documented medical benefits from improved pain relief to better cardiovascular health. In adults, most opportunities to laugh follow visual or auditory stimulation, which is processed in the dorsal upper pons area of the brain. For this Japanese study, Inoue et al (2022) hypothesised a possible connection between visual impairment and laughter, with a negative relationship indicating a need to prevent and treat visual impairment and implement social support programmes for affected individuals.

The authors analysed cross-sectional data of 19 452 community-dwelling independent individuals aged 65 years and over, and the outcomes measured were the frequency of laughter and the number of opportunities to laugh.

The study found that the number of participants who laughed almost every day was 8197 (42.1%) and that there was a statistically significant association between visual impairment and laughter, with poor vision having a negative impact and good vision having a positive impact. Further, when visual status improved, both the frequency of laughter and the number of opportunities to laugh increased. The findings suggest that improved vision may help to promote laughter, ‘provoking physical and mental benefits and a joyful life that relates to well-being.’

Foot reflexology could be used to reduce pain associated with dressing changes

In this Letter to the Editor, Kiasari (2022) notes that pain during dressing change is one of the main complications of burn patients, which can lead to anxiety in this group. Further, pain can negatively affect the wound healing process and quality of life, and long-term pain anxiety can weaken the immune system, which also slows down wound healing.

While sedative agents like benzodiazepines and non-steroidal anti-inflammatory drugs can control pain and pain anxiety, they can also have unwanted side-effects. Kiasari (2022) suggests that foot reflexology massage may be useful as a non-pharmacological complementary treatment. Foot reflexology massage can reduce stimulation of the sympathetic nervous system and reduce pain anxiety, and the author cites evidence that it can improve both immune function and the physical, psychological and social aspects of pain in burn patients.

It appears that evidence suggests that foot reflexology massage is a simple, low-cost, and practical intervention that can reduce the pain and pain anxiety severity of burns patients. However, the author makes clear that previous studies in this field of research are very limited: ‘Therefore, it is recommended that future studies evaluate the effect of foot reflexology massage on pain and pain anxiety severity during dressing change in burn patients.’