“Although the birth hospitalization lasts only a few days, it sets a critical foundation for establishing breastfeeding, which can influence health outcomes like childhood asthma,” said study author Laura Placke Ward MD, IBCLC, FAAP, co-director for the Center for Breastfeeding Medicine at Cincinnati Children’s Hospital Medical Center.

“Our study underscores the importance of hospital practices in supporting exclusive breastfeeding, as these early experiences may impact long-term health,” she added.

The 9,649 subjects included children born between 2017-2019.

The investigators reported that 81% of the children received some breast milk during their birth hospitalization, and 31% of them were fed exclusively with breast milk during their birth hospitalization.

Five percent were eventually diagnosed with asthma during childhood.

After adjusting for sex, race, and insurance status, newborns fed only with breast milk achieved a 22% lower rate of asthma during childhood compared to those who did not receive any breast milk or did not receive breast milk only.

“This finding highlights the need for greater emphasis on supporting and promoting exclusive breastfeeding during the early days of life,” Ward said. “By focusing on these crucial first days, we may impact children’s health and potentially reduce the risk of chronic conditions like asthma.”

Researchers reported on Sept. 21, 2024 at the annual meeting of the European College of Neuropsychopharmacology.

Lead researcher Tommaso Barba, PhD candidate from Imperial College, London, said, “This is the first work to compare the long-term effects of these two drugs in the context of overall well-being, not just freedom from depression.  In previous work we had found that both treatments led to comparable improvements in alleviating symptoms of depression at the 6-week mark, such as sadness and negative emotions.  However, this work shows that psilocybin outperformed escitalopram in several measures of well-being, meaning in life, work and social functioning. These results appeared to be maintained over a 6-month follow-up period. In addition, in previous work we had found that psilocybin also improves sexual drive, in contrast to SSRIs which tend to lower libido in many patients. So overall it seems psilocybin might give additional positive mental health benefits.”

As background, the authors noted that SSRI drugs (selective serotonin reuptake inhibitors), such as Prozac, Paxil and Zoloft, are widely used to treat depression, but about a third of patients don’t respond to such treatment.

“SSRIs work well, but not for everyone,” Barba said. “They are also associated with some side effects. However, this work implies that psilocybin generally seems to offer a real alternative, and perhaps additional benefits, to people who are worried about taking conventional antidepressants.”

The researchers undertook a 6-month phase 2, randomized trial with 59 subjects diagnosed with moderate to severe depression.

They treated 30 of the subjects with a single dose of psilocybin and 29 subjects with a six-week course of escitalopram.

All subjects received similar psychological support of around 20 hours.

Both groups showed significant improvement in depressive symptoms up to 6 months after treatment. Notably, the subjects treated with psilocybin reported greater improvements in social functioning and psychological connectedness.

“This is important because improving connectedness and having greater meaning in life can significantly enhance a person’s quality of life and long-term mental health,” said co-first author Dr. David Erritzoe, Clinical Director and Deputy Head of the Centre for Psychedelic Research, Imperial College, London.

Erritzoe added, “Psilocybin is still an experimental drug; it has not yet been approved for general use. It is administered in highly controlled and protected environments: these precautions are not found in recreational psychedelic use, which is known for having unpredictable and potentially harmful effects, especially for vulnerable people struggling with mental health issues.”

Researchers reported this finding on Sept. 13, 2024 at the annual meeting of the European Association for the Study of Diabetes (EASD).

The two drugs are FDA-approved for the treatment of type 2 diabetes and for weight loss. They are also being widely used off-label to treat overweight or obesity in patients with type 1 diabetes.

“Some of the mechanisms through which semaglutide and tirzepatide lower blood sugar in type 2 diabetes are also likely to be relevant in type 1 diabetes,” said study leader Janet Snell-Bergeon, MPH, PhD, of the University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. “In addition, an increasing number of adults with type 1 diabetes are living with overweight or obesity.  These conditions can lead to insulin resistance, which makes it more difficult for people who have type 1 diabetes to control their blood sugar. Therefore, these drugs may be particularly beneficial for these patients,” she added.

The investigators evaluated retrospectively medical charts of 100 adults diagnosed with T1D, 50 of whom had been prescribed semaglutide and 50 of whom had been prescribed tirzepatide.  The majority of the subjects (84% of those prescribed semaglutide and 100% of those prescribed tirzepatide) were also overweight or obese.

The subjects were matched with 50 controls by age, sex, diabetes duration, body mass index (BMI) and glycated haemoglobin (HbA1c). The controls had not been prescribed a weight loss drug treatment.

The investigators gathered data generated at baseline before treatment began and up to one year later.

For those who had been drug treated and for the controls, respectively, mean age was 40 vs. 41 years, sex was 71 vs. 72 % female, diabetes duration was 26 vs. 27 years, BMI was 34kg/m2 vs. 34kg/m2 and HbA1c was 7.3% vs 7.3%.

Insulin pumps were used by 75% of those receiving the study drugs and 80% of controls.  The rest of the subjects injected insulin multiple times daily.

After 12 months, there were statistically significant larger average declines in weight in both of the drug-treated groups when compared to controls, who gained a small amount of weight.

The patients treated with tirzepatide lost more than twice as much weight as those taking semaglutide.

The subjects treated with semaglutide lost 9.1% of their body weight on average over 12 months, equating to 19.2lb (8.7kg).  Their BMI decreased by 3kg/m2, on average, over 12 months.

The subjects treated with tirzepatide lost 21.4% of their body weight, on average, over 12 months, equating to 49.4lb (22.4kg). Their BMI decreased by 7.5kg/m2, on average, after 12 months.

Reduction in HbA1c was greater in the semaglutide (-0.42%) and tirzepatide (-0.62%) treated groups than in controls (0.02%), but there was no significant comparative difference between the tirzepatide group and the semaglutide group

There was a statistically insignificant tendency toward greater change in BMI, weight, and HbA1c in the insulin pump users vs. those on multiple daily injections.

There were no reported hospitalizations from severe hypoglycemia or ketosis.

The authors concluded, “In this real-world, off-label study of use of semaglutide and tirzepatide in OW/OB [overweight/obese] adults with T1D, we observed weight loss of 21% and 9% in the tirzepatide and semaglutide users, respectively, with similar improved glucose control over up to a year of follow-up. There was a tendency towards higher changes in BMI, weight and HbA1c in the patients using an insulin pump. As off-label use of these drugs is increasing in patients with T1D, larger, prospective trials are needed to evaluate their efficacy and safety in OW/OB patients with T1D on different therapeutic regimens.”

Dr Snell-Bergeon added, “A growing number of individuals with type 1 diabetes are living with obesity, partly because the intensive insulin therapy that is required to manage blood sugar levels can cause weight gain. Semaglutide and tirzepatide can lead to significant weight loss in these patients and improve their blood sugar levels, which could reduce their risk of complications of obesity and diabetes, including heart disease and eye, nerve and kidney problems.”

“Our findings should raise alarm bells in nearly every nation worldwide,” said senior author Dariush Mozaffarian MD, Jean Mayer Professor of Nutrition and director of the Food is Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University in Boston. “The intakes and trends we’re seeing pose a significant threat to public health, one we can and must address for the future of a healthier population.”

The investigators extracted and analyzed data from the Global Dietary Database, a comprehensive accounting of what people worldwide eat and drink.

They generated the first global estimates of trends in sugar-sweetened beverage consumption among young people.

They defined sugar-sweetened beverages as soda, juice drinks, energy drinks, sports drinks, and home-sweetened fruit drinks such as aguas frescas with added sugars and containing more than 50 kcal per 1 cup serving.

In 2018, sugar-sweetened beverage intake among young people varied significantly by world region, averaging 3.6 servings per week worldwide and ranging from 1.3 servings per week in South Asia to 9.1 in Latin America and the Caribbean..

They reported that sugar-sweetened beverage intake among children and adolescents increased by an average of 23% (0.68 servings/week) from 1990 to 2018. The largest increases were in sub-Saharan Africa (2.17 servings/week).

Notably, 56 (30%) of the 185 countries included in the analysis had an average sugar-sweetened beverage intake of 7 or more servings/week.

The authors concluded, “This study found that intakes of SSBs among children and adolescents aged 3-19 years in 185 countries increased by 23% from 1990 to 2018, parallel to the rise in prevalence of obesity among this population globally. SSB intakes showed large heterogeneity among children and adolescents worldwide and by age, parental level of education, and urbanicity. This research should help to inform policies to reduce SSB intake among young people, particularly those with larger intakes across all education levels in urban and rural areas in Latin America and the Caribbean, and the growing problem of SSBs for public health in sub-Saharan Africa.”

The findings appeared on Jan.17, 2024 in JAMA Network Open.

“The most important finding here is that patients experiencing depression have a choice in terms of their treatment between therapy or medications,” said lead author Waguih IsHak, MD, vice chair of Education and Research in the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Center in Los Angeles, California. “Patients who prefer not to be on medication can do behavioral activation therapy with similar results.”

Behavioral activation is a treatment for depression promoting engagement in personalized pleasurable activities selected by patients.

This randomized, comparative effectiveness trial was conducted from 2018 to 2022, including 1-year follow-up. Subjects included inpatients and outpatients diagnosed with heart failure and depression.

The primary outcome was depressive symptom severity at 6 months, measured using the Patient Health Questionnaire 9-Item (PHQ-9). The PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.

The investigators enrolled 416 subjects (243 male), with a mean age 61years.

They randomized 208 subjects to behavioral activation and 208 to drug therapy.

At baseline, mean PHQ-9 scores were 14.54 in the behavioral activation group and 14.31 in the drug therapy group.

Both behavioral activation and drug therapy subjects achieved a 50% reduction in depressive symptoms at 6 months. There was no statistically significant difference between the cohorts for the primary outcome of PHQ-9 at 6 months, with a mean score of 7.53 for behavioral activation vs 8.09 for drug therapy.

The authors summarized, “This comparative effectiveness randomized clinical trial of BA [behavioral activation] vs MEDS [drug therapy] found that among patients with HF [heart failure] and depression, there was reduced depressive symptom severity by nearly 50% in both interventions at 6 months, with no significant differences between BA and MEDS groups at 3, 6, or 12 months. There were no significant differences in secondary outcomes of HRQOL [physical and mental health-related quality of life], caregiver burden, morbidity, or mortality between BA and MEDS groups at 3, 6, or 12 months. However, patients receiving BA, compared with those receiving MEDS, had slightly higher physical HRQOL improvement at 6 months and were less likely to visit the ED with fewer days hospitalized at 3, 6, and 12 months, which were all statistically significant. There was no significant difference in hospital readmissions.”

They published their findings on Dec. 19, 2023 in BMJ Nutrition Prevention & Health.

As background, the authors noted, “Women seem to have more difficulty quitting smoking than men. This is particularly concerning as smoking puts women at a higher risk of developing smoking-associated diseases.”

Findings from a previously published trial indicated that dulaglutide significantly reduced weight gain in those of both genders who quit smoking. But the prior analysis did not determine whether weight loss was specific to gender.

In this new analysis, the investigators re-analysed the data for gender differences in weight loss or gain during 12 weeks after smoking cessation.

They included 255 adults in the analysis. All had been daily smokers (155 women, 100 men).

All subjects had received weekly dulaglutide (1.5 mg) or placebo (0.9% sodium chloride). In addition, all received standard smoking cessation care including varenicline 2 mg/day plus behavioral counselling, which lasted for 12 weeks.

The investigators defined “substantial weight gain” as an increase of more than 6% in body weight.

The investigators found that women were more likely than men to put on substantial weight during the timeframe of the study.

Dulaglutide treatment was associated with a significantly lower risk of substantial weight gain among the women.

Substantial weight gain among subjects in the placebo treatment cohorts (not receiving dulaglutide) was much more frequent in women than in men, 24% for women vs 5% for men.

Notably, substantial weight gain in women treated with dulaglutide was significantly less common than those who did not get the drug, 1% (1 out of 83) vs 24% (17 out of 72) (p<0.001).

Similar statistically significant weight gain effects did not appear among the men, 0% (0/44) in the dulaglutide-treated group vs 5% (3/56) in the placebo-treated group.

“Dulaglutide reduced post-cessation weight gain in both genders and was very effective in preventing substantial weight gain, which seems to be a   specific observation in females,” the authors concluded.

“Our results clearly demonstrate that GLP-1 RAs are significantly more effective than popular anti-diabetic drugs, such as Metformin or insulin, at preventing the development of CRC,” said co-lead investigator Nathan Berger, MD., professor of experimental medicine at Case Western Reserve School of Medicine in Cleveland, Ohio.

“To our knowledge,” added co-lead researcher Rong Xu Ph.D, professor of biomedical informatics at Case Western School of Medicine, “this is the first indication this popular weight-loss and anti-diabetic class of drugs reduces incidence of CRC, relative to other anti-diabetic agents.”

As background, the authors noted that GLP-1 RA drugs have shown efficacy as anti-diabetic and weight-loss agents. They said, “Because overweight/obesity is a major risk factor for colorectal cancer (CRC), we hypothesize that GLP-1RAs are associated with a decreased risk for CRC in patients with T2D [Type 2 diabetes] compared with non–GLP-1RA antidiabetics. We conducted a nationwide, retrospective cohort study among drug-naive patients with T2D comparing GLP-1RAs with 7 non–GLP-1RA antidiabetics, including metformin and insulin, which are suggested to influence CRC risk.”

The study population was comprised of 1,221,218 subjects diagnosed with T2D, who were prescribed antidiabetic medications from 2005 to 2019, who had no prior antidiabetic medication use and who had no prior colorectal cancer diagnosis.

Patient cohorts used for comparisons in the study were matched (1:1) for demographics, adverse socioeconomic determinants of health, preexisting medical conditions, family and personal history of cancers and colonic polyps, lifestyle factors (exercise, diet, smoking, and alcohol drinking), and procedures such as colonoscopy.

The primary outcome was the first diagnosis of colorectal cancer that occurred within 15 years from the first prescription of GLP-1RAs vs non–GLP-1RA antidiabetics.

Among 22,572 subjects with Type 2 diabetes who were treated with insulin, the researchers identified 167 cases of colorectal cancer.  Among another cohort of 22,572 matched subjects treated with GLP-1 Ras, they identified 94 cases of colorectal cancer.  Subjects treated with GLP-1 RAs achieved a 44% reduction in the incidence of colorectal cancer.

When compared to 18,518 Type 2 diabetes subjects treated with Metformin, 18,518 subjects treated with GLP-1 RAs achieved a 25% comparative reduction in colorectal cancer.

Notably, GLP-1RA treatment was associated with a significantly lower colorectal cancer risk in subjects with obesity/overweight when compared with insulin treatment.

“The research is critically important for reducing incidence of CRC in patients with diabetes, with or without overweight and obesity,” Berger said.

“There are many treatment options available to those with migraine. However, there is a lack of head-to-head comparisons of the effectiveness of these treatment options,” said study author Chia-Chun Chiang, MD, neurology specialist at the Mayo Clinic in Rochester, Minnesota, “These results confirm that triptans should be considered earlier for treating migraine, rather than reserving their use for severe attacks,” she added.

The investigators conducted a retrospective analysis of data from 3,119,517 migraine attacks during a 6-year period among 278,006 users of an e-diary smartphone application. The app allowed subjects to record migraine frequency, triggers, symptoms and medication effectiveness.

The investigators evaluated the data for the efficacy of 25 acute medications from seven drug classes —  acetaminophen, NSAIDs, triptans, combination analgesics, ergots, anti-emetics, and opioids.

The investigators used this information to compare the efficacy of each drug to ibuprofen.

“Different doses and formulations of each medication, according to the generic names, were combined in this analysis,” they noted.

The study found that the top three classes of medications which were more effective than ibuprofen were triptans, ergots and anti-emetics. Triptans were five times more effective than ibuprofen, ergots were three times more effective and anti-emetics were two and a half times more effective.

In terms of individual drugs, eletriptan which was six times more effective than ibuprofen, zolmitriptan which was five and a half times more effective and sumatriptan which was five times more effective.

Eletriptan was helpful 78% of the time, zolmitriptan was helpful 74% of the time and sumatriptan was helpful 72% of the time.

Ibuprofen was helpful 42% of the time.

Notably, NSAID drugs other than ibuprofen were 94% more effective than ibuprofen, with ketorolac being helpful 62% of the time, indomethacin being helpful 57% of the time and diclofenac being helpful 56% of the time.

Acetaminophen was helpful 37% of the time and was 17% less effective than ibuprofen.

Combination aspirin, acetaminophen and caffeine was 69% more effective than ibuprofen.

The authors concluded. “Our findings that triptans, ergots and anti-emetics are the most effective classes of medications align with the guideline recommendations and offer generalizable insights to complement clinical practice. This study provides Class IV evidence that for patients with migraine, selected acute medications (e.g., triptans, ergots, anti-emetics) are associated with higher odds of user-rated positive response than ibuprofen.”

Chaing added, “For people whose acute migraine medication is not working for them, our hope is that this study shows that there are many alternatives that work for migraine, and we encourage people to talk with their doctors about how to treat this painful and debilitating condition.”

“The results of this study suggest a strong association between covid-19 vaccination before infection and reduced risk of receiving a diagnosis of PCC. The findings highlight the importance of primary vaccination against covid-19 to reduce the population burden of PCC,” the authors said.

The purpose of the population-based Swedish study was to evaluate the prophylactic effect of primary covid-19 vaccination (first two doses and first booster dose within the recommended schedule) against postcovid-19 condition.

The 589,722 subjects were all adults, with covid-19 diagnoses first registered between December 27, 2020 and February 9, 2022. They were tracked from first infection until death, emigration, vaccination, reinfection, a postcovid-19 condition diagnosis or end of follow-up (30 November 2022), whichever happened first.

Subjects who had gotten one dose of a covid-19 vaccine before infection were deemed to have been vaccinated.

The primary endpoint was a clinical diagnosis of postcovid-19 condition.

They reported that, of 299,692 vaccinated subjects with covid-19, 1,201 (0.4%) received a diagnosis of postcovid-19 condition during follow-up. This compared with 4,118 (1.4%) of 290,030 unvaccinated subjects who developed postcovid-19 condition.

Those who had been vaccinated once or more prior to their first infection were 58% less likely to receive a diagnosis of post-covid-19 condition than unvaccinated subjects.

Notably, vaccine efficacy increased with each additional dose before infection. The first dose reduced the risk of post-covid-19 condition by 21%, two doses by 59%, and three or more doses by 73%.

The authors concluded, “The results from this study highlight the importance of complete primary vaccination coverage against covid-19, not only to reduce the risk of severe acute covid-19 infection but also the burden of post-covid-19 condition in the population.”

The findings were published on October 5 in the New England Journal of Medicine and presented the same week at the annual meeting of the European College of Neuropsychopharmacology.

“This is the first trial to compare this new treatment with a standard existing treatment for treatment-resistant depression, and so it’s a really necessary study. The results are very positive,” said lead author Dr. Andreas Reif, professor of psychiatry at Goethe University in Frankfurt, Germany,

Reif continued, “We were testing patients at two endpoints (goals). The first major endpoint was to understand the proportion of patients who achieved remission after eight weeks. The second was determining the proportion of patients who met the first endpoint and who were relapse free at the end of the trial period (i.e. after 32 weeks). We measured the effects of treatment using a standard depression scale, the Montgomery‑Åsberg Depression Rating Scale.”

The investigators enrolled adult subjects with treatment-resistant depression, all of whom had taken antidepressants, such as an SSRI (selective serotonin reuptake inhibitor) or an SNRI (serotonin and norepinephrine reuptake inhibitor).

They assigned 336 subjects to treatment with esketamine nasal spray plus an SSRI or SNRI, and  340 subjects to quetiapine plus an SSRI or SNRI. Treatment lasted eight weeks, followed by 24 weeks of maintenance therapy.

For the primary endpoint, at eight weeks, 28% of the subjects taking esketamine plus antidepressants had achieved remission compared to 18% remission in the quetiapine-treated group.

At the 32-week secondary endpoint mark, 22% of the subjects taking esketamine plus antidepressants remained in remission, compared to 14% of the subjects treated with quetiapine plus antidepressants.

“There were other differences we saw over time,” said investigator Professor Allan Young of Kings College, London, UK. “For example the patients receiving the esketamine treatment had fewer depressive symptoms than those taking quetiapine. We found that patients receiving esketamine NS were around 1.5 times as likely to experience remission at Week 8 than those receiving quetiapine XR.  In addition, esketamine NS‑treated patients were 1.5 times as likely to achieve the key secondary endpoint, remaining relapse free through Week 32. Indeed, by Week 32, approximately half of patients receiving esketamine NS were in remission, while two thirds were responders, emphasising the importance of continuing treatment in those who do not achieve remission in the acute phase”.

Commenting on the findings, Dr Josep Antoni Ramos-Quiroga from Vall Hebron University Hospital (CIBERSAM) and Autonomous University of Barcelona, Spain said, “The results of this study show the superior response and safety of esketamine nasal spray when compared with quetiapine. This gives people with treatment-resistant depression more safe treatment options.”

The findings were released on Oct 2, 2023 from the Annual Meeting of The European Association for the Study of Diabetes (EASD).

“Our long-term analysis of semaglutide in a large and diverse cohort of patients with type 2 diabetes found a clinically relevant improvement in blood sugar control and weight loss after 6 months of treatment, comparable with that seen in randomised trials,” said investigator Avraham Karasik, MD, lead author and professor at the Institute of Research and Innovation at Maccabi Health Services in Israel, the second largest health maintenance organization in the country.

“Importantly, these effects were sustained for up to 3 years, supporting the use of once weekly semaglutide for the long-term management of type 2 diabetes,” Karasik added.

The investigators retrospectively evaluated data on the use of semaglutide in patients from the Maccabi diabetes registry.

They identified 23,442 eligible subjects who had redeemed at least one prescription for weekly semaglutide subcutaneous injections (0.25, 0.5 and 1 mg) between August 2019 and December 2022. These same subjects had also undergone one blood sugar control check (HbA1c) 12 months before, and 6 months after, starting treatment.

Prior to semaglutide treatment, 30% of the subjects were treated with insulin, and 31% were treated with another GLP-1 RA (glucagon-like peptide-1 receptor agonist.

Six months after beginning semaglutide treatment, subjects achieved an average lowering of their HbA1c by 0.77% (from 7.6% to 6.8%) and reduced their body weight by 4.7 kg (from 94.1 kg to 89.7 kg).

Further analysis of data beyond 6 months showed that reductions in HbA1c and weight continued over time during the 3-year follow-up.

Among subjects who began semaglutide treatment at least two years before the end of study period and showed high adherence to treatment, HbA1c was reduced by 0.76% after 24 months and by 0.43% after 36 months. Boody weight was reduced by 6.0 kg after 24 months and 5.8 kg after 36 months.

“In this large real-world study, we were able to show durable reductions in HbA1c and body weight with emphasis on drug adherence. Data are in line with results in randomised controlled trials and show the long-term stable benefit of once weekly semaglutide,” Karasik said.

“When we controlled for unhealthy lifestyle behaviors, the strong association between chronotype and diabetes risk was reduced but still remained, which means that lifestyle factors explain a notable proportion of this association,” said first author Sina Kianersi, DVM, PhD, a postdoctoral research fellow in the Brigham and Women’s Hospital’s Channing Division of Network Medicine in Boston, USA.

The investigators analyzed data from 63,676 female nurses from the Nurses’ Health Study II collected from 2009-2017. The data included self-reported chronotype (self-perception as an evening person or a morning person), diet quality, weight and body mass index, sleep timing, smoking behaviors, alcohol use, physical activity, and family history of diabetes.

The researchers determined diabetes status from the self-reports and medical records.

Approximately 11 percent of the subjects reported having a ‘definite evening’ chronotype, and about 35 percent reported having ‘definite morning’ chronotype. The remaining population, around half, were labeled as ‘intermediate,’ with no clear chronotype.

The researchers reported that, before accounting for lifestyle factors, an evening chronotype was associated with a 72 percent increased risk for developing diabetes compared to a morning chronotype.

After accounting for lifestyle factors, an evening chronotype was still associated with a 19 percent increased risk of diabetes.

Corresponding author Tianyi Huang, MSc, ScD, an associate epidemiologist in the Brigham’s Channing Division of Network Medicine said, ““Chronotype, or circadian preference, refers to a person’s preferred timing of sleep and waking and is partly genetically determined so it may be difficult to change. People who think they are ‘night owls’ may need to pay more attention to their lifestyle because their evening chronotype may add increased risk for type 2 diabetes.”

The authors concluded, “Middle-aged nurses with an evening chronotype were more likely to report unhealthy lifestyle behaviors and had increased diabetes risk compared with those with a morning chronotype. Accounting for BMI, physical activity, diet, and other modifiable lifestyle factors attenuated much but not all of the increased diabetes risk.”