An apple a day keeps the doctor away – so will 12 weeks of free, healthy food delivered to a patient's door keep the cardiologist at bay?
That's what Dr Andrew Reynolds, of the University of Otago's Department of Medicine, is hoping to find out with funding announced today from the Health Research Council.
Dr Reynolds is one of six Otago researchers to be granted a $150,000 Explorer Grant – funding allocated to support transformative research ideas that have a good chance of making a revolutionary change to managing New Zealanders' health.
His project – looking at whether providing healthy groceries to patients recovering from a heart attack is less expensive on the health system than the cost of providing future medical care – joins other successful recipients whose projects include biomarkers for heart disease, tumour diagnosis and treatment, and tissue repair.
Heart disease is a primary cause for morbidity and mortality in Aotearoa New Zealand, Dr Reynolds, a Heart Foundation Fellow, says.
“We know that long term dietary choices are leading factors in heart attack incidence, particularly high saturated fats and sodium intakes, and low fibre or vegetable intakes.
“This is a randomised controlled trial of 300 participants based in Otago, Southland, and Canterbury who are recovering from a heart attack. The trial itself is 12 weeks of free groceries delivered to participants' front doors. We want to know if providing these groceries improves their health status,” Dr Reynolds says.
The participants will then be followed for 12 months after the trial to see if what they eat is changed by participating in the study, and if the healthy food has any long-term health benefits, such as preventing further heart attacks.
“Our long-term goal is to assess if providing free health groceries during recovery from a heart attack is less-expensive on the health system than the cost of providing future medical care.
“The cost to the health care system is high due to the hospital time, the medications and procedures, and the level of care people need from our fantastic nurses and hospital staff during their immediate recovery. Because of this we are really interested to see if the cost of delivering groceries to everyone with a heart attack is cheaper than the cost of re-hospitalisations for those who have a secondary event.
“We also recognise there may be other benefits to health beyond preventing secondary events with free grocery provision, so we are trying to capture those as well.”
Dr Reynolds knows changing people's habits may be the biggest hurdle of the research.
“Our recent work has shown that increasing fibre intake is really beneficial for those who have had a heart attack or have hypertension. So, on paper this trial makes sense. However, changing what we eat in the long term can be really difficult, as we are creatures of habit.
“We are also looking seeking to understand this better, and see if we can come up with better ways to support people to change what they eat in the future.”
Nationally, 17 Explorer Grants were awarded, totalling $2.55 million.
Otago Explorer Grant recipients, $150,000, 24 months
Dr Christoph Goebl, Christchurch
A novel and simple tool for tumour diagnosis and treatment prognosis
Immunohistochemistry staining of tissue sections is widely used for cancer diagnosis and treatment monitoring. Currently available methods do not account for the structure of the target protein. Motivated by the success in neurodegenerative diseases where aggregated protein states can selectively be detected, we aim to develop improved staining methods against cancer markers. We recently discovered that the crucial tumour suppressor protein p16 can form aggregated structures similar to protein deposits found in age-related diseases. These aggregated deposits called amyloids are an inactive version of the protein and knowledge about the p16 state might be of great value for patient treatment. We will develop immunohistochemistry staining methods that will allow to discriminate the active p16 from the inactive state. Our method might also allow to determine the treatment success of newly developed anti-cancer drugs against binding partners of p16, therefore supporting treatment and prognosis of cancer patients.
Associate Professor Rajesh Katare, Dunedin
SalivarymMicroRNAs as prognostic biomarkers of heart disease
Patients with chronic ischaemic heart disease (IHD) require regular follow-up to monitor the progression of the disease and response to treatment. Currently, apart from echocardiography, which requires patients to visit a speciality centre and is expensive, there is no other test available to precisely monitor the heart function during regular follow-up. In this proposal, we aim to explore whether measuring heart-enriched microRNAs from salivary samples can be a simple tool to determine the progress of the disease and the effectiveness of the therapy. In addition, we will also explore the comparable expression pattern of salivary miRNAs among different ethnic populations in New Zealand. Salivary miRNAs as biomarkers for patients is a unique and unexplored area of research that will transform the way for the use of biomarkers in clinical practice. In the long term, this could result in developing a novel biomarker assay to test the prognosis of IHD.
Dr Rachel Purcell, Christchurch
Circulating bacterial DNA for early detection of metastasis in colorectal cancer
New Zealand (NZ) has one of the highest rates of colorectal cancer (CRC) in the world, and it is increasing in younger people and in Māori, making this both a health and equity issue. The microbiome has been strongly implicated in CRC, and we will harness our knowledge of the microbiome to develop a completely novel application of liquid biopsies, circulating bacterial DNA, as an early detection tool for metastasis in CRC. Our study findings have the potential to revolutionise cancer management, and reduce overall mortality from CRC.
Dr Robin Quigg, Dunedin
Hauora Māori me kā papa takaro ki Ōtepōti/Māori health & parks: a Dunedin study
A kaupapa Māori project is proposed that will inform and contribute to identifying and describing the relationships between health and land for Māori, actioning recommendations of the IUCN Healthy Parks Healthy People guidelines in Aotearoa me Te Waipounamu* (New Zealand, NZ). Hauora Māori me kā papa tākaro ki Ōtepōti/Māori health & parks: a Dunedin study will focus on the parks and reserves of the Dunedin City Council, firstly understanding the health context of parks and reserves for mana whenua and takata (tangata) whenua, though Thought Space Wānanga and pūrākau, then how they can be integrated with parks and reserve management. The defined area of this City Council provides a deliverable project with opportunity for investigation of these innovative approaches, mindful of the disparate historical narratives between the existing presentation of many manicured and managed parks with their specimen trees and other plantings.
Dr Alexander Tups, Dunedin
Glucoregulation by leptin: The missing piece to the puzzle of tissue repair?
It is well known that individuals with obesity or type 2 diabetes have severely impaired tissue repair, but the underlying mechanisms are largely unknown. We and others could show that the body weight- and glucoregulatory hormone leptin is crucial for tissue repair. In this application, we propose a novel mechanism that may add the missing piece to the puzzle of tissue repair. Rather than being an indirect complication of metabolic disease, we propose that tissue repair is facilitated by the glucoregulatory action of leptin, a function of the hormone that is typically impaired in metabolic disease. Furthermore, we seek to investigate whether an evolutionary very old signalling pathway mediates these effects, which we have identified as a novel target of leptin. Our study may lead to new treatments for tissue repair, including wound dressings that may contain long acting leptin versions.
Dr Andrew Reynolds, Dunedin
Free healthy groceries in heart attack recovery: He kai ora, he oraha manawa
What we do or don't eat is the largest risk factor for global morbidity and mortality. However, our dietary choices are not entirely our own, being guided by overt and covert external influences. The health consequences of our dietary choices are therefore not an individual responsibility but a systems one, requiring new solutions that support individuals. We wish to consider the role of free grocery provision in the usual care for those recovering from a heart attack, as an equitable means to improve individual and community health. We have chosen heart attack recovery given its contribution to healthcare systems costs, and the potential of healthy foods to improve patient outcomes. Free healthy foods for patients has not been implemented in Aotearoa New Zealand, however results from this cost effectiveness analysis may pave the way for such progressive models of health care in in the future.
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