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 men and women's use of healthcare and death after dementia diagnosis; alteplase after stroke; obesity and in vitro fertilization (IVF) outcomes; and ultraprocessed foods, minimally processed foods, weight loss, and cardiometabolic risk factors.

Program notes:

0:40 Alteplase after stroke

1:40 Expand time window

2:40 Imaging crucial in use

3:20 Utilization of healthcare and mortality in those with dementiaopens in a new tab or window

4:20 Women used much less healthcare

5:20 Focus on prevention in women

5:50 IVF outcomes and weight lossopens in a new tab or window

6:50 Did not appear to increase success with IVF

7:45 Ultraprocessed foods versus minimally processed foods

8:45 Randomized to one diet or the other for 8 weeks

9:45 Minimally processed foods improved risk factors

10:45 Short period of study

11:42 End

Transcript:

Elizabeth: What's the difference in healthcare utilization and mortality after dementia diagnosis in men and women?

Rick: Expanding the use of clot-dissolving drugs in people that have had a stroke.

Elizabeth: How do minimally processed foods and ultra-processed foods compare when weight loss is attempted?

Rick: And what is the effect of weight loss before in vitro fertilization on reproductive outcomes?

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, how about if we turn first to JAMA and this perennial issue -- it sure feels like to me, I can't think of how many times we've talked about it -- what about alteplase after somebody has a stroke?

Rick: In many places, especially low- and middle-income countries, they don't have access to thrombectomy. Instead, they use clot-dissolving drugs. And, in fact, we do that in the United States at centers where thrombectomy is not available. Typically, we restrict the use of these clot-dissolving drugs like alteplase to individuals that present in the first 3 or 4� hours of stroke. Studies have shown that they're effective in improving neurologic outcome.

What's happened is we now have an advanced imaging that can sometimes identify people that have had a stroke for longer periods of time, in which there's still some area of the brain that hasn't really died. It's at risk and it can recover with clot-dissolving drugs. So the question is, can we expand that time window in those particular individuals?

And that's what this study did. It took place in 26 different stroke centers across China, where they took 372 individuals that were having an acute stroke. Imaging suggested that they had salvageable brain tissue, and these are individuals that presented somewhere between 4� to 24 hours into the symptoms, and they randomized them to receive either alteplase or standard medical therapy. And then they looked at their functional independence 90 days after the stroke.

The individuals that received alteplase, 40% of those had significant improvement in their neurologic outcome, they were functionally independent, versus 26% in the control group. The downside was that the risk of intracranial hemorrhage was somewhat higher. It was about 4% in those that received alteplase and about 0.5% in those that received standard treatment.

Elizabeth: And let's mention, of course, that this is ischemic stroke that we're talking about. Let's talk about the imaging and how good is it at determining whether there is still salvageable brain tissue. That clearly is the crux of the decision-making.

Rick: It is and it's fairly good. And you say, "Well, how can brain tissue that it hasn't received blood for 4� or 5 or 6 or even up to 24 hours, how can it be salvageable?" Well, oftentimes they have collateral blood vessels. And if we can restore blood by either doing a thrombectomy or here by giving thrombolytic therapy, we can actually get neurologic recovery in that particular area. And the imaging they used was CT imaging and it's pretty widespread available.

Elizabeth: Sounds to me like these expanding indications for alteplase and other clot-busting drugs -- they're just going to keep on expanding.

Rick: In very specific patient groups.

Elizabeth: Let's turn to JAMA Neurology, and this provocative study, I thought, examined the sex differences in mortality and healthcare utilization after somebody has been diagnosed with dementia.

It was a nationwide cohort study using Medicare enrollment data. They looked at it from 2014 to 2021 with 8 years of follow-up. They had almost 6 million patients, 65 years of age or older, who had a diagnosis code in their record for dementia with at least 1 year of prior fee-for-service Medicare enrollment. What they were looking at was the hazard of all-cause mortality, the utilization of common health services, all-cause hospitalizations, skilled nursing facility stays, neuroimaging services, and physical or occupational therapy.

They found that females had lower crude 1-year mortality rates than males, lower cause of all-cause hospitalizations. They died less often than the males did. The males also had increased hazards of hospice stay, the utilization of neuroimaging, and hospitalization for neurodegenerative disease or behavioral disturbance. So the authors basically conclude that taking a look at this will help us to target or to understand better what happens in this trajectory.

Rick: I think that's a fair assessment. If you look at 100,000 people, how many of those die from dementia in women versus men? For women, about 73 deaths per 100,000, and in men, 56 per 100,000. Is it because women are more likely to die from it or do they just have a greater incidence?

Treatment for that is very different and what this study shows is it's not that women die more frequently from it, it's just that they have a higher incidence. So if we're going to address this in males, we're going to try to decrease mortality. If we're going to try to address this in women, we're going to try to decrease the incidence. We're going to focus on prevention.

Elizabeth: I agree. I found it interesting that drilling down into this finding, that although women experience dementia more often, it appears that they don't have all the other constellation of things that men do.

Rick: Unfortunately, what that means is, when women develop dementia, they're more likely to have a protracted course. Addressing prevention in women is going to be incredibly important.

Elizabeth: Couldn't agree more. Let's turn to Annals of Internal Medicine, your next one. What about IVF outcomes and weight loss?

Rick: Obesity is associated with an increased risk of female infertility. It leads to hormone dysregulation, ovulatory dysfunction, and negatively affects female fertility, even in women that have normal, regular ovulation. So, many women seek in vitro fertilization. If obesity is associated with trouble becoming pregnant and we're going to apply IVF, what's the effect of weight loss in women that are obese before in vitro fertilization on reproductive outcomes?

So what these investigators did was they pulled the results of 12 different randomized controlled trials that looked at over 1900 women. And what they discovered is that there was pretty moderate certainty that pre-IVF weight loss was associated with an increase in pregnancy rates, about a 21% increase in pregnancy rates. The interesting thing, though, is these were pregnancies that resulted from unassisted conception. They increased by 47%. Whereas the effect on pregnancies resulting solely from IVF was still uncertain. It didn't appear that it increased the success of IVF. Is there harm? That wasn't the case at all.

Elizabeth: Isn't that interesting? Suggesting, to me at least, that obesity somehow compromises reproductive fitness.

Rick: Well, and I think that's probably a good way to term it. There are a lot of different ways that obesity affects it, but calling it "pregnancy fitness" is a pretty good way of looking at it.

These studies provide a general overview, but there are a lot of details that are missing, Elizabeth. It doesn't tell how much weight loss one needs, which particular diet is better. So although the general picture is weight loss can increase the ability to conceive -- unassisted conception -- there's still a lot of details that need to be worked out.

Elizabeth: Well, it would sure be great, wouldn't it, if some weight loss would enable women to not have to undergo IVF at all, which is pretty all-encompassing a strategy for reproduction? And it's also very expensive.

Rick: Yeah. Pretty remarkable.

Elizabeth: Turning finally then to Nature Medicine, our Darth Vader of the hour, ultraprocessed foods. This is yet one more look at our ultraprocessed foods versus minimally processed diets, and their effect on weight loss and cardiometabolic health.

This is a small study. They took 28 people who were randomized first to their minimally processed foods and then consumed an ultraprocessed food diet, and 27 people who did the ultraprocessed foods first and then did minimally processed foods. They were provided with these two 8-week ad libitum diets that followed the U.K. Eatwell Guide. So the only thing that was different between them was the processing of the foods.

Their primary outcome was, what was the within-participant difference in percent weight change between those diets from baseline to week 8? And their participants were blinded to the primary outcome, although I think that's a little bit comical. Because if you're getting potato chips in one diet and you're getting whole potatoes in another, I would think it would be pretty obvious which of them you were consuming.

Ultimately, the minimally processed foods resulted in greater weight loss, kind of unsurprising to me, although some of their other outcomes were not different between the minimally processed and the ultraprocessed foods. They also looked at things like their fat mass, body fat percentage, visceral fat rating, total body water mass. Those were lower with the minimally processed foods. The same thing happened with systolic blood pressure, lower with the minimally processed. Hemoglobin A1c and triglycerides were lower at 8 weeks, compared with baseline, only with the minimally processed foods. So a number of outcomes that were helpful in terms of eating that diet versus the ultraprocessed foods.

Rick: Other studies have looked at processed food; they didn't control for the diet. One always questions, is it the ultraprocessed food or other dietary habits that the individuals have?

So these particular patients, this small group, had the Eatwell guideline, the U.K. public guidance. It talks about the amount of fat, protein, carbohydrates, food groups, so every single patient got that exact same thing. The only thing that changed was ultraprocessed versus minimally processed foods. And remember that ultraprocessed foods are those that have additives and industrial ingredients. So that was all that changed.

And, as you mentioned, there was weight loss with both. Probably not because of the processing, but probably because they were eating the proper diet to begin with. But then the weight loss was better with minimally processed than ultraprocessed foods.

The cardiometabolic differences between the two, they kind of varied a little bit. I mean, nobody came out a clear winner. Let's keep in mind that this was just 8 weeks of diet. One can't presume what the long-term benefits are with this short period of study, but you need to see it in a larger population. It's very difficult to do in a larger population, by the way, and for a longer period of time.

Elizabeth: One curiosity that they report was the LDL cholesterol was lower on the ultraprocessed food diet versus the minimally processed foods, which I thought was inexplicable.

Rick: Yeah. That's why I said cardiometabolic, there were some things that said, "Oh, minimally processed is better." Others said, "Ultraprocessed is better." I think the overwhelming data is the ultraprocessed foods really don't provide any benefit. The maximal benefit is, if you're going to eat healthy, let's use minimally processed foods.

Elizabeth: I like that message. On that note, 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.