[Vol 36] Medi-Scene: Your Weekly Health News Update

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Mediscene Vol 361. How to sustain a healthy heart against TFA (Trans Fatty Acid)

WHO has called for elimination of TFA from the global food supply by 2023.It is considered a health best buy – a policy measure that will positively impact several million lives. In the last few decades, India has witnessed a significant rapid change in dietary patterns that has led to the rise of NCDs and related comorbidities in young children, adolescents, young adults, and the elderly. According to the World Health Organization (WHO), ‘replacement of TFA with unsaturated fatty acids decreases the risk of CHD, in part, by eliminating the negative effects of TFA on blood lipids. Besides the harmful effect on lipid profile, there are indications that TFA may also increase inflammation and endothelial dysfunction as well. The recently launched REPLACE report 2020 by WHO emphasizes on the elimination of TFA from food supply chains as one of the most effective public health interventions and one of the ‘Best Buys’ for NCDs. This can be efficiently done by promoting the replacement of industrial TFA with healthier fats and oils. Eliminating trans-fat from food supply chains is one of the most effective public health interventions to reduce NCDs as they are non-essential dietary components. Many countries globally have achieved success in TFA reduction through combined efforts like compulsory trans-fat labelling, public awareness campaigns, and engagement with industry to reformulate products and regulation of levels of trans- fats nationally and locally for most effective outcomes.

2. Diabetes death risk cut by a third with regular exercise

Yun-Ju Lai, MD, and colleagues from the Puli branch of Taichung Veterans General Hospital in Nantou, Taiwan, found that persons with type 2 diabetes who exercised at moderate to high intensity had a 25%-32% decreased risk for death, compared with those who did not exercise.  Sheri Colberg-Ochs, PhD, professor emerita in exercise science at Old Dominion University in Norfolk, Va., in an interview said, “There is really nothing surprising about these results as others have shown that regular participation in physical activity lowers both overall mortality rates and morbidity. Regular exercise participation lowers the risk of mortality in almost all populations with many different health conditions. It is not specific to people with type 2 diabetes. These data add further support to the ADA [American Diabetes Association] recommendations by again suggesting that being more active leads to many health benefits for people with type 2 diabetes.” Dr. Lai and colleagues analyzed data on 4,859 subjects drawn from two Taiwanese databases – the National Health Interview Survey and the National Health Insurance research database – to study what effect exercise “capacity” had on the risk for death in those with type 2 diabetes. Dr. Lai said, “Information about physical activity during leisure time was collected by asking the questions: ‘How often do you exercise every week? What kind of exercise do you do? How long do you exercise?’ We included nearly all kinds of exercise in the analysis, such as jogging, swimming, walking, dancing, riding, and so on.” The study’s findings, however, were clear: Those who exercised at a higher level had a significantly decreased risk for all-cause mortality than did those with no exercise habits.

3. Knee Osteoarthritis pain can be reduced by turmeric capsules

A new clinical study suggests that people with knee osteoarthritis who take daily turmeric capsules feel less pain in the knee joint than their peers who don’t take this supplement. Researchers randomly assigned patients with symptomatic knee osteoarthritis to take two capsules of turmeric capsules (n=36) or placebo (n=34) daily for 12 weeks. At the end of the study period, turmeric improved knee pain on a visual analog scale (VAS) by -9.1 mm (95% CI, -17.8 to -0.4 mm) compared with placebo, but did not alter effusion-synovitis volume on magnetic resonance imaging. Senior study author Dr Benny Eathakkttu Antony of the Menzies Institute for Medical Research at the University of Tasmania in Hobart, Australia in an interview said, “The moderate effect we found in our trial from a short-term study is reassuring for turmeric as a treatment option. However, there are no long-term studies that explored the efficacy and safety of turmeric extracts for the treatment of osteoarthritis. There are no disease-modifying drugs approved to treat knee osteoarthritis, Antony and colleagues note in the Annals of Internal Medicine. Other pain relievers including acetaminophen and nonsteroidal anti-inflammatory drugs have only mild to moderate effects and are associated with adverse events, the researchers point out. Dr Antony further added, “Turmeric extracts are generally considered as safe in moderate doses usually seen in the over-the-counter medication. Curcumin, the most active constituent of turmeric, is generally classified ‘generally recognized as safe’ by the U.S. FDA as a food supplement.” Romy Lauche, deputy director of research at the National Centre for Naturopathic Medicine at Southern Cross University in East Lismore, NSW, Australia said, “Supplements and herbal products are one of many options that some patients may prefer over pharmacological therapies, and to some extent the treatment choice for knee osteoarthritis may come down to individual patient preferences. Supplements as well as pain medication may be able to support individuals with their osteoarthritis, for example by reducing their pain and helping them to be physically active again. However, which supplement or medication works is very individual, and patients may need to test different approaches to find the best management strategy before considering invasive treatments such as joint replacement surgery.”

4. Meat & alcohol increases colorectal cancer risk

A new meta-analysis has largely confirmed what is already known about the lifestyle factors that increase and those that decrease the risk of developing colorectal cancer. The use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a decreased risk for colorectal cancer, the new article concludes. But it also adds a number of other factors that are associated with a decreased risk for the disease, including taking magnesium and folate supplements and eating dairy products, fiber, soy, and fruits and vegetables. On the other hand, consumption of meat and alcohol was associated with an increased risk for colorectal cancer in almost all of the analyses included in this article. The authors of the study wrote, “Furthermore, in most cases, we were unable to identify an optimal dose and duration of exposure/intake for any of the products, even in the case of low-dose aspirin and other compounds that have been extensively assessed.” The American Institute for Cancer Research and the World Cancer Research Fund have published several reports during the past 10 years on the effect of diet, nutrition, and/or physical activity on risk for several cancer types. The studies included randomized controlled trials and observational studies. Most of the meta-analyses found a protective effect for aspirin, lowering the risk by between 14% and 29% even at doses as low as 75 mg/d, with a dose-response effect of up to 325 mg/d. The certainty of evidence was moderate.

5. Govt to focus on mental health, besides COVID-19: Tope

Public health minister Rajesh Tope told the valedictory session of HospitalTech 2020 National Healthcare Summit organised by CII., “The increase is a point of concern, we want to address it. The government is looking forward to adopting effective technological interventions to improve healthcare. We are expanding our Tele-ICU network and looking for more cost-effective models.” In July-end, the state task force recommended psychiatric pills be prescribed to Covid patients if their psychosis and fear over the condition was high. “All hospitals realized early on that counselling had to be part of treatment. Even patients needing post-Covid treatment need counselling,’’ said a senior doctor. WHO has warned about a mental health pandemic that is likely to follow Covid-19. Studies done to understand the impact of SARS 18 years back showed that 100% of patients had sleep disorders, 30% traumatic memories and 10% depressive thoughts. A survey by Suicide Prevention India Forum showed 54.7% mental health professionals reported an increase in people seeking therapy for the first time. SPIF founder Nelson Moses said, “With the lengthy lockdown, forced isolation, fear of virus, financial insecurity, domestic violence and rising anxiety, the crisis has deepened.”

6. Study shows link between white rice intake and type 2 diabetes risk

A new analysis of the multinational, multiethnic Prospective Urban Rural Epidemiology (PURE) study suggests that consuming more than 3 cups/day of white rice significantly increases the risk of diabetes compared with eating lower amounts. Compared with participants who ate less than 1 cup/day (150 g/day) of cooked white rice, those who ate more than 3 cups/day (> 450 g/day) had a 20% higher risk of developing diabetes over a mean follow-up of 9.5 years (P = .003). Second author Viswanathan Mohan, MD, PhD, DSc, chair and chief diabetologist at Dr. Mohan’s Diabetes Specialties Centre, India told an online health magazine platform that, “Among people of middle and lower socioeconomic status, rice consumption is very high because other food choices such as meat, fish, chicken, vegetables, and fruits are all quite expensive. Hence, people make up the calories [they need] by eating ‘polished’ rice. What we are suggesting is that protein intake should be increased, and this can come…in the form of beans and legumes, which if consumed along with the rice, would help reduce the overall glycemic load of the diet.” A total of 132,373 participants aged 35 to 70 from 21 different countries were included in the new analysis, which excluded anyone with diabetes at baseline. During the study interval, 6129 individuals developed incident diabetes. Dr Mohan further added, “There could be several reasons for this. Firstly, the actual intake of white rice in China was substantially lower than it was in other countries, especially among those living in South Asia. Secondly, the type of rice the Chinese consume may be slightly different than elsewhere in that it is ‘sticky’. Probably more importantly, however, in China, they do consume a lot of animal protein as well as vegetable protein.” In addition, there were only a handful of rice mills in India until the early 1970s, a situation which has now completely changed: there are now over a million rice mills in the country. Dr Mohan said, “This naturally led to increased consumption of high polished white rice,” Mohan emphasized, “and in general, people like the color, taste, and smell of white rice better [than brown rice] plus brown rice takes longer to cook and is difficult to chew. People need to be encouraged to be more physically active, which would also help reduce obesity rates and with it, diabetes risk.”

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