Tuberculosis: Vaccine, Intervention, Prevention & Control

TB Vaccine: BCG

Bacille Calmette-Guérin (BCG) is one of the vaccines in the Expanded Program of Immunization (EPI). In many countries where tuberculosis is common BCG vaccine is ideally administered at birth. BCG vaccine main action is to prevent the complications of tuberculosis, such as extrapulmonary/non-infectious tuberculosis in children. BCG vaccine is not recommended to prevent and control tuberculosis in adult populations because BCG vaccine does not have any considerable effect on Tuberculosis transmission or incidence.

TB Intervention

Directly Observed Treatment, Short Course (DOTS) is ranked by the World Bank as one of the "most cost-effective of all health interventions”. Over the past two decades DOTS is developed from best practice experiences, clinical trials, and programmatic operations of tuberculosis control. In 1995, WHO launched the DOTS strategy for combating Tuberculosis. Ever since 184 countries out of 212; including the tuberculosis high burden countries (22 countries) have adopted DOTS. Even in the poorest countries the DOTS has produced cure rates of up to 95% (cure rates are for tuberculosis in the absence of HIV or multi-drug resistance).  DOTS program halts transmission of tuberculosis to the susceptible populations. It ensures that the full course of treatment is followed and decreases the risk of multidrug-resistant tuberculosis (MDR Tuberculosis). DOTS program is cost-effective to save a life, in some parts of the world a full course of drugs to treat typical tuberculosis case cost as little as US$16.  A sputum smear positive cases are more likely to be treated successfully if, treated under a DOTS program.

Tuberculosis is cured when the patient's sputum test reverts to negative at least once during treatment and then remains negative in the last month of treatment. Persons with a positive skin test reaction are of the high-risk groups and are prescribed drug (isoniazid) daily, for nine months. Isoniazid acts by killing tuberculosis bacteria that are inactive in the body. It also prevents the development of active tuberculosis from latent infection. However, before starting one-drug treatment it is very crucial to rule out active Tuberculosis. The latent tuberculosis is treated with only one drug whereas active tuberculosis is treated with four drugs at first.

HIV/Tuberculosis Co-infection

The co-infection of HIV/Tuberculosis is a lethal combination because each accelerates the other’s progress. Globally, almost 10% of all new tuberculosis cases are HIV positive. However, this number varies widely on a country basis and can be as high as 80%. In developing countries many people infected with HIV develop tuberculosis as the first manifestation of AIDS. The tuberculosis infection progresses faster in HIV-positive individuals therefore, if left undiagnosed or untreated it is almost certain to be rapidly fatal.

An estimated annual death due to HIV/AIDS is 2 million, 1.7 million due to tuberculosis and 2.1 million due to malaria. The global tuberculosis incidence is estimated to be expanding, to a certain extent, because of the powerful interaction between HIV and Tuberculosis. It is a leading cause of death among HIV positive population, 1 in 3 people with HIV/AIDS die of tuberculosis. Worldwide tuberculosis accounts for about 30% of AIDS deaths. An HIV positive person infected with tuberculosis is 50 times more likely to become sick with tuberculosis than HIV negative person infected with tuberculosis. Relative to HIV status, the lifetime risk of developing tuberculosis is 5% to 10% if HIV negative and 50% if HIV positive.

Direct observation of treatment (DOT) for co-infection of HIV/Tuberculosis

Evidences show that 85.4% of HIV-infected tuberculosis patients survived who received short-course chemotherapy (SCC) with direct observation of treatment (DOT). Whereas, only 56.7% of HIV-infected tuberculosis patients survived who received SCC without DOT. Tuberculosis could be prevented in millions of people infected with HIV through the use of IPT. Once active tuberculosis disease is ruled out, IPT can be safely used. There is no evidence that IPT increases isoniazid drug resistance.

The best way to prevent and control Tuberculosis is to find and successfully treat all cases of sputum smear positive (active) pulmonary Tuberculosis. The focus on case finding among high risk groups e.g., the homeless, malnourished, elderly, injection drug users, prisoners, and HIV-positive populations, facilitates case detection and earlier onset of treatment. This approach minimizes the number of inadequately treated tuberculosis patients, and the risk of drug resistance.

The health care workers can protect themselves against Tuberculosis infection by using masks when collecting or handling sputum, and caring for patients with sputum smear positive tuberculosis disease. The use of ultraviolet light is recommended in laboratories where sputum is collected from tuberculosis patient. Better ventilation is encouraged in the household, clinic, or workplace.

The key challenges to Tuberculosis control and prevention are; lack of political will and commitment at all levels, weaker health systems for case detection,  inadequate referral and follow-up, lack of adequately trained workforce, inadequate tuberculosis drug supply for all cases, discontinuous tuberculosis drug supply, tuberculosis/HIV Co-infection, tuberculosis drug resistance, insufficient technology for tuberculosis diagnosis, outmoded vaccine (BCG). Tuberculosis prevention program requires the community to understand the importance of Tuberculosis control. This helps identify creative solutions in communities where daily access to the health system is not possible. While implementing Tuberculosis prevention program it is crucial to understand the community perspectives. The programs are to be designed to address both TB/HIV infection and multidrug resistance (MDR), issues of stigma and discrimination associated with both tuberculosis and HIV among hard-to-reach groups and increase outreach. Addressing these issues will have a significant impact on Tuberculosis disease. Community education campaign is very effective in sharing knowledge that Tuberculosis is a curable disease.

Weight-loss drug approved by FDA for use in US

According to official figures more than one-third of adults in the US are now obese. The obesity rate among American adults has approached 35%.  A new weight-loss drug Qsymia has been approved by the US Food and Drug Administration (FDA). The approvals are the first in the US for 13 years.


FDA had already approved another anti-obesity drug Belvig last month. Qsymia is a combination of drugs phentermine and topiramate which has been already approved by the FDA and is marketed for aiding weight loss and preventing seizures. Qsymia is recommended for patients who are overweight or obese and have at least one other weight-related condition. The findings from two studies showed an average weight loss of 6.7% and 8.9% among patients who took Qsymia, along with dietary changes and exercise.

The drug is not recommended for pregnant women as it may harm fetuses. The drug is also not recommended for patients with heart disease or who have recently suffered a stroke because the drug can increase heart rate. Further trials are needed to assess the impact of the drug on cardiac health.

Source: http://www.bbc.co.uk/news/world-us-canada-18881232

Drug Resistance Tuberculosis

Tuberculosis drug resistance is a man-made amplification of spontaneous mutations in the genes of tuberculosis bacilli. Anti-tuberculosis (TB) drug resistance is a major public health problem. It threatens the progress made in TB control and care Worldwide. Drug-resistant TB occurs when the drugs used to treat TB are misused or mismanaged in drug-susceptible TB patients.  The administration of improper treatment regimens, issues of drug compliance are the few actions that lies beneath the improper use of TB drugs. The drug resistance arises in region/places where TB control programmes are weaker.

Multidrug-resistant tuberculosis (MDR Tuberculosis) refers to resistance to two or more anti-tuberculosis drugs. The two most potent TB drugs isoniazid and rifampin are used to treat all persons with TB disease.  When sputum smear positive/active tuberculosis is treated with a single drug “acquired drug resistance” may be produced. The growth of susceptible strains to that drug is suppressed, but the multiplication of drug-resistant strains is permitted. Acquired drug resistance may be caused by irregular drug supply, inappropriate prescription, or poor adherence to treatment. Primary resistance may occur when a person is infected for the first time with a drug-resistant strain of tuberculosis from someone who harbors MDR tuberculosis and may not be receiving adequate treatment. WHO estimates that every year 490,000 MDR tuberculosis cases emerge, with more than 110,000 deaths. Surveillance data shows that several countries with the highest burden of tuberculosis have significant multidrug resistance tuberculosis. 

 

Extensively drug-resistant TB (XDR TB) is a rare type of MDR TB. XDR TB is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs.  XDR TB is resistant to the most potent TB drugs therefore; patients are left with much less effective treatment options. People with HIV infection and weaker immune system are more likely to develop TB disease once they are infected, and also have a higher risk of death once they develop TB. XDR TB is of special concern for people with HIV infection or other conditions that can weaken the immune system. The latest report of highly lethal strains of XDR tuberculosis underscores the potential threat of expanding resistance. XDR tuberculosis has been found in 45 countries; at least one case has been confirmed in these countries.  The highest rates of MDR tuberculosis are in countries of the former Soviet Union and China.  In the two countries with the highest tuberculosis burden, China and India, 8% and 5% of tuberculosis cases are estimated to have MDR tuberculosis. Drug-resistant tuberculosis in global "hot spots” has already reached a level at which the relatively inexpensive DOTS approach is not adequate to address the tuberculosis problem.

DOTS remain the most important intervention for preventing MDR tuberculosis. DOTS treat regular tuberculosis if, administered properly. It also prevents the development of drug-resistant tuberculosis. If drug-resistant tuberculosis is already present among a population programmatic management of MDR and XDR tuberculosis strategy should be considered. The DOTS and programmatic management of MDR and XDR tuberculosis needs to be an integrated approach. The most important way to prevent the spread of drug-resistant TB is by focusing on the issue of compliance. It is very crucial for the patient to understand that prescribed TB drugs should be taken regularly as directed. The prescribed doses should not be missed and treatment should not be stopped prematurely. Better counseling techniques needs to be in place, so that during patient follow-up the issues related to non-compliance should be diagnosed and addressed.  Another way to prevent drug-resistant TB is by avoiding exposure to known drug-resistant TB patients in closed or crowded places such as hospitals, prisons, or homeless shelters.

TUBERCULOSIS: DIAGNOSIS

Tuberculosis is diagnosed based on clinical symptoms, sputum smear microscopy (SSM), chest x-rays, culture and tuberculin skin test (TST). The clinical symptoms of active pulmonary Tuberculosis disease are cough for three or more weeks, spitting up blood in the sputum, weight loss, fever or night sweats for three or more weeks, fatigue, feeling unwell, and loss of appetite, chest pain or discomfort, shortness of breath or difficulty in breathing.

 

Sputum smear microscopy (SSM): The gold standard diagnosis for tuberculosis is sputum smear microscopy (SSM). It is a simple technology that allows visual identification of the tuberculosis bacilli. It is very specific and most reliable way of identifying the presence of tuberculosis bacilli. Sputum smear microscopy is used to detect acid-fast bacilli (AFB) in the sputum. The appearance of AFB in the sputum (smear positive) indicates transmittable pulmonary disease. Currently, sputum smear microscopy is the only diagnostic tool that is affordable for low-income countries.

Chest radiography has been used usually in the past to diagnose tuberculosis; it is however much less specific when compared to sputum smear microscopy.

Culture is a tool for tuberculosis diagnosis but is not used as a part of routine tests. Culture is a more sensitive laboratory technique and is usually done when the symptoms are strongly suggestive of tuberculosis and sputum smear microscopy/SSM is negative. (Example: Culture is recommended in cases of tuberculosis in children and HIV/AIDS patients, because in these cases the number of tuberculosis bacilli in the sputum is often reduced and sputum smears are less likely to be found positive.)  Growth on solid culture media takes three to four weeks and requires special laboratories while growth in liquid culture is much faster. The average time for detection is 10 to 14 days. This system is known as Mycobacteria Growth Indicator Tube (MGIT)-tuberculosis culture and can be used to diagnose multidrug resistant tuberculosis (MGIT-DST).

MODS (Microscopic Observation Drug Susceptibility) are an alternative liquid culture system for case detection and drug susceptibility testing which is still under research.

Tuberculin skin test (TST): A small amount of fluid – tuberculin – is injected in the skin in the lower part of the arm. A positive test is measured by the size of the indurations (hardness, bump, and swelling) at the injection site two to three days post-injection. In developing countries this test is not used as a diagnostic test. In the presence of prior history of BCG vaccination the (TST) test may be positive. Persons with a positive skin test reaction are in high-risk groups and are prescribed drug (isoniazid) daily, for nine months. Isoniazid kills tuberculosis bacteria that are inactive in the body and prevents the individual from developing active tuberculosis from latent infection.

TUBERCULOSIS FACTS

Prevalence of Tuberculosis

One third of the world's population is infected with Tuberculosis. It kills an estimated 1.5 to 2 million people each year. Tuberculosis is one of the world's leading killers; on average it kills one person every 15 seconds. About 95% of people infected with tuberculosis live in developing countries. In low-income countries tuberculosis is one of the world's top ten causes of death. The low and middle-income countries account for more than 90% of tuberculosis cases and deaths. Tuberculosis is one of the leading causes of death among women in developing countries. More than 900 million women are infected with tuberculosis worldwide.

The World Health Organization estimates that 8.8 million people develop active Tuberculosis disease every year.  Active Tuberculosis had a case fatality of about 50% before the dawn of antibiotics.

Impact

Tuberculosis has significant impact on economy and development. More than 75% of tuberculosis-related disease and death occurs in people between the ages of 15 and 54–the most economically active segment of the population. Tuberculosis interfere individual’s ability to work for months. It is estimated that the lost of earnings totals up to 30% of annual household income, while some families may lose 100% of their income. The impact of tuberculosis further aggravates poverty.

The World Bank and WHO has reported tuberculosis as a leading cause of "healthy years lost" among women of reproductive age. Women bear a disproportionate burden of poverty, ill-health, malnutrition, and diseases worldwide. Tuberculosis causes more deaths among women than all causes of maternal mortality combined. Women of reproductive age, once infected with tuberculosis are more susceptible to develop tuberculosis than their male counterpart. Further women of this age group are at greater risk of infection with both tuberculosis and HIV.

Causes

Tuberculosis is a disease caused by the bacterium Mycobacterium Tuberculosis. Poverty is the underlying cause of (tuberculosis) infection in rural areas. Overcrowded housing, lack of proper food, proper sanitation contributes to development of tuberculosis. About 70% to 80% patients have tuberculosis of the lungs. Although tuberculosis can infect any part of the body, it usually infects the lungs. The tuberculosis of the lungs is known as pulmonary tuberculosis, it can be either latent tuberculosis infection (aka/inactive) or active tuberculosis disease (infectious).

The individual with latent tuberculosis infection have no symptoms of tuberculosis, they don’t feel sick and are non-contagious. However, they usually react positively to a tuberculin skin test (TST) even though chest x-ray and sputum tests are normal. While individual with active pulmonary tuberculosis have symptoms of tuberculosis infection. They are contagious and usually react positively to a tuberculin skin test, may have abnormal chest x-ray and a positive sputum smear or tissue culture.

Types

Tuberculosis that occurs outside the lungs is known as extra-pulmonary tuberculosis. Besides the lungs, other parts of the body that can be commonly affected are the lymph nodes, brain, kidneys, bone. Tuberculosis can be latent in these sites as well. A person can concurrently have pulmonary and extra-pulmonary tuberculosis. Extra-pulmonary tuberculosis can be seen more often in immune-suppressed people and in children.

Tuberculosis is not spread by insects, blood supplies, water, dishes, or clothing, or by someone with latent tuberculosis. In a healthy person, the two major transmission factors for tuberculosis are: concentration of infected respiratory droplets in the air and, the period of time exposed to contaminated air.  Each person with active pulmonary tuberculosis can infect 10 to 15 people per year. Only patients having active tuberculosis of the lungs (pulmonary tuberculosis) or throat (laryngeal tuberculosis) can infect others. Anyone can become infected with tubercular bacilli; a person has to inhale only a small number of active tuberculosis bacilli to become infected. Tuberculosis bacilli may reside in the tissues of the body, but may not be active (growing, reproducing, and causing increasing damage in the host). 
Latent tuberculosis infection: Inactive tuberculosis is called as latent tuberculosis infection. In such cases tuberculosis bacteria are asleep. As long as the tuberculosis bacteria remain latent, they do not harm the body and are not contagious. People with latent tuberculosis infection are the ones who have been exposed to tuberculosis and have acquired the tuberculosis organism. Latent tuberculosis infection may develop into active tuberculosis infection when the immune system weakens. When latent tuberculosis gets “activated” it develops into a case of pulmonary tuberculosis (sputum smear positive) that is infectious and can be transmitted to others. The typical symptoms like cough, fever, night sweats, weight loss, and lack of energy develops. In some instances, the person may cough up blood when active pulmonary tuberculosis is more advanced. 
Some of the factors that increase the risk for progression from latent tuberculosis infection to active tuberculosis disease are HIV, weakened immune system, poor health status (e.g., cancer, substance abuse, diabetes). Women are more likely to progress from latent tuberculosis infection to active tuberculosis disease whereas; men are more likely to have latent tuberculosis infection.

Fish Oils: Don't help ward off Dementia

Cochrane reviews  pulled together high quality scientific evidence and revealed that participants taking omega-3 supplements doesn't offer any  protection than a dummy pills. The randomized controlled trials that tracked the health of individuals over a period of three-and-a-half years, found that participants taking omega-3 scored no better in standard tests of memory and mental performance than those given a placebo.

Based on these findings the experts concluded that taking fish-oil supplements to ward off dementia could be a waste of time. It is still unclear whether the supplement might help promote some brain protection if  taken for much longer period. The experts therefore recommends long-term studies to be carried out for more conclusive results. Taking omega-3 supplements, doesn't seem to have  any benefit for cognitive health among older people. The use of omega-3's  to prevent dementia has been scientifically backed. 

Eating a healthy balanced diet, including fish and other natural sources of omega-3, is  important for maintaining good health. While taking omega-3 supplements may not be the key to staving off cognitive problems, eating plenty of oily fish, such as mackerel, salmon and sardines provides omega-3, an important fatty acid, which has been linked to a lower risk of heart disease. It is advisable that a healthy diet should include at least two portions of fish a week, including one of oily fish. Heart healthy is also good for the brains therefore the Mantra/formula to reduce the risk of cognitive decline and dementia in later life is to maintain a healthy weight, eat a balanced diet, exercise and keep blood pressure in check.

Quinoa (Keen-Wah): The Magic Food

Quinoa is grown along the coastal regions of South America to 13,000 feet up in the Andes of Bolivia. Quinoa is an incredible hardy plant; it is naturally tolerant to large number of abiotic stresses, or natural environmental factors. Varieties of quinoa have been adapted to suffer through frost, drought, high heat, and nutrient-deficient soil. More importantly, quinoa grows excellently in low nutrient soil.

In ancient South America Quinoa was considered as the "Gold of the Incas" as it increased the stamina for their warriors. In appearance it resembles like a millet or big poppy seed. It taste nutty and feels more or less like eating cracked wheat or couscous. Speaking precisely, quinoa is not a true grain. It is the seed of the Chenopodium or Goosefoot plant. Nonetheless, it is used as a grain and substituted for grains because of its cooking characteristics. Quinoa is now widely cultivated in Peru, Chile and Bolivia for its nutritious seeds. They are referred to as "little rice." In South America the quinoa seeds are used in making various soups and bread. It is also fermented with millet to make a beer-like beverage. A sweetened decoction of the fruit is used medicinally, as an application for sores and bruises. The saponin removed from the quinoa is used as detergent for washing clothes and as an antiseptic to promote healing of skin injuries. The Quinoa seeds are rinsed to remove their bitter resin-like coating- k/a saponin- before cooking. Saponin is easily washed off, as soon as, quinoa seeds are placed in a strainer and rinsed thoroughly with water.

Quinoa in comparison with others grains, provides not only a similar amount of energy- in calories- but also provides more nutrients. Quinoa is a good source of protein, and consist almost perfect balance of all eight essential amino acids needed for tissue development in humans. It is exceptionally high in lysine, cystine and methionine (essential amino acids) which are typically low in other grains. Quinoa can therefore be a good complement for legumes, as these are often low in methionine and cystine. Quinoa also contains albumin, a protein that is found in egg whites, blood serum, and many plant and animal tissues. Not only is the protein complete, in addition to that, quinoa grains also have by and large ratio of protein to carbohydrate, because the germ makes up about 60% of the grain. Quinoa seed is also high in calcium and iron. It is a relatively good source of vitamin E, some of the B vitamins, magnesium, phosphorus, and a very good source of manganese.

A field trial was carried out in 2009, to explore the potential for quinoa to grow in climatic conditions of South Eastern Europe. The trial confirmed that even under rain-fed conditions without fertilization, quinoa seed yielded as high as 1.721 t ha−1. The quinoa seed quality were remarkably good, with protein content ranging from 15.16 to 17.41 % on a dry weight basis, depending on whether seeds were processed. It also confirmed the potential of quinoa seeds as a valuable ingredient in the preparation of highly nutritious foods because of its amino acid and mineral composition. Quinoa seeds had higher contents of most essential amino acids, especially lysine, than wheat flour. Trial also provided evidence that addition of quinoa seeds extremely enhanced wheat bread nutritional value. (Stikic et al., 2012)

Quinoa fits well in the recent health trends – It’s a whole grain, gluten-free, and organic. Quinoa may be useful in reducing the risk for diabetes. The quinoa seeds are often substituted for rice in rice dishes and are believed to help feel full for longer. Quinoa can be an ideal food for people with diabetes if, accepted as an alternative to white rice. These magnificent grains are gluten free, which makes this a nutritious and palatable alternative grain for those with gluten sensitivity. Quinoa helps control blood pressure as it is very low in cholesterol and sodium and has the highest of all the whole grains in potassium. It fact, it can be a great source of protein for vegetarians as 1 cup of grain contains 10.4 grams of protein. NASA has proposed quinoa as an ideal food for long-duration space flights whereas; the United Nations has designated quinoa as a "super crop", for its potential to feed the hungry poor of the world.

The bottom-line is---- quinoa supports good health. It’s the only plant foods that are a complete protein, which offers all the essential amino acids in a healthy balance. 

References:

Chauhan, G. S., Eskin, NAM., Tkachuk, R. (1992). Nutrients and Anti-Nutrients in Quinoa Seed, Cereal Chem. 69(l): 85-88

Loubaton, E. Food and Globalization, New York Times.

Stikic, R., et al., (2012). Agronomical and nutritional evaluation of quinoa seeds (Chenopodium quinoa Willd.) as an ingredient in bread formulations. Journal of Cereal Science, 55, 2: 132–138

White rice consumption and risk of Type 2 Diabetes

White Rice is a staple food and eaten regularly in many Asian countries. On average, people from Asian countries ate about four servings of white rice daily whereas the people from Western countries ate less than five servings a week. A study suggests eating white rice might be pleasing to the palate, but it significantly increases the risk of type 2 diabetes when eaten regularly. Findings from this study further confirm that regularly eating white rice is not a good idea. The study found that each serving per day of white rice consumption was associated with an 11% increase in risk of diabetes in the overall population.

Hu et al., (2012) conducted a study to review evidence on the association between white rice consumption and risk of type 2 diabetes. Researchers analyzed the results of studies in Asian countries (China and Japan) and in Western countries (the U.S. and Australia). None of the participants had diabetes at the study baseline. The review of the four studies involved around 350,000 participants tracked anywhere from four to 22 years. The review took into account factors such as weight, exercise levels and diet of volunteers. During follow-up research, around 13,200 people developed diabetes.

The result affirms that the more servings of white rice eaten per day, the higher are an individual’s chances of developing Type 2 Diabetes. The authors estimate that the risk of type 2 diabetes is increased by 11 percent with each increased serving of white rice (assuming 158 grams per serving). Researchers concluded higher consumption of white rice is associated with a significantly increased risk of type 2 diabetes, especially in Asian (Chinese and Japanese) populations. This association between consumption of white rice and risk of type 2 diabetes appears to be stronger for Asians than for Western populations.

White rice is the predominant type of rice eaten worldwide and has high Glycemic Index (GI) values. High GI diets are tied with a greater risk of type 2 diabetes. The culture of white rice consumption seen in Asian countries will increase the risk for diabetes substantially. Rice has been a staple food for thousands of years in the Asian population. Given the Asian culture of consuming white rice regularly the risk seems unlikely to be transferred to the Western countries because of the low consumption of rice. Nonetheless, increasing trend of obesity and diabetes is rampant in western world despite of less white rice consumption. The transition in nutrition characterized by decreased physical activity levels; improved security and varieties of food that has led to increased prevalence of obesity and insulin resistance in the western world. Hence, it’s important to think about how food plays into our culture. It’s all about what we eat, what we do, and our genes. We can’t change our genes; however we can make some healthy lifestyle changes.

The study found a link between white rice consumption and diabetes, but it did not prove that the food causes the blood-sugar disease. The study was not designed to show how white rice may increase the risk for diabetes. Whatsoever, researchers have their theories based on Glycemic Index (GI) -- white rice has the highest glycemic index (which means it can cause a sudden spike in blood sugar levels). White rice also has fewer nutrients, including fiber and magnesium, which may help lower the risk for developing type 2 diabetes. This study limits the ability to establish cause and effect; therefore to determine if, actually white rice increases the risk of type 2 diabetes controlled studies are needed. Future research should focus on how to eat less, consume foods of lower glycemic index and exercise more to prevent diabetes and obesity.

Reference: Hu EA, Pan A, Malik V, Sun Q. (2012). White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ , 344:e1454.

Building muscle reduces Diabetes risk

A study suggest that increasing muscle mass can help lower risk for type 2 diabetes. Globally as the obesity epidemic is on rise the prevalence of diabetes is anticipated to increase. Type 2 diabetes occurs when there is too much glucose in the blood either because of insufficient insulin production in the pancreas or cells becoming insulin-resistant. Individuals’ with insulin resistance are predisposed to raise blood sugar levels. Diabetes leads to inadequate blood sugar control, which can damage the kidneys and cause blindness, heart disease and strokes. Type 2 diabetes has been strongly linked to an unhealthy diet, a sedentary lifestyle and being overweight.

This study was conducted to find out whether increased muscles, regardless of obesity levels, are associated with improved blood glucose control. Researchers conducted a cross-sectional analysis of National Health and Nutrition Examination Survey III between 1988 and 1994. Data from 13,644 adults were evaluated. The measurement used were homeostasis model assessment of insulin resistance (HOMA-IR), blood glycosylated hemoglobin level, prevalence of transitional/pre or overt diabetes (PDM), and prevalence of overt diabetes mellitus.

The researchers found that for each 10 percent increase in the skeletal muscle index/SMI (the ratio of muscle mass to total body weight) there was an 11 percent reduction in insulin resistance (insulin resistance is a precursor to diabetes) and 12 percent reduction in pre-diabetes (a condition characterized by higher-than-normal blood sugar levels but not high enough to be diabetes). These relationships apprehended even after the researchers took into account other factors (age, ethnicity, sex, and generalized and central obesity) affecting risk for insulin resistance and pre-diabetes.

The findings suggest that higher muscle mass (relative to body size) is associated with better insulin sensitivity and lowers the risk of Diabetes Mellitus. Building muscle mass with resistance training exercise may play a role in lowering the risk of type 2 diabetes. Resistance exercise may help people with type 2 diabetes by better using the insulin that they produce.

The authors suggest that even though after starting an exercise program if you don't lose weight, never give up hope because your body fat still gets converted to muscle. We gain muscle loosing fat so even if the weight is the same, the balance shifts. The authors conclude that further research is needed to determine the effect of appropriate exercise interventions designed to improve insulin sensitivity and glucose metabolism in at-risk individuals.

Reference: Srikanthan, Preethi and Karlamangla, S. Arun. Relative Muscle Mass Is Inversely Associated with Insulin Resistance and Prediabetes. Findings from The Third National Health and Nutrition Examination Survey. The Journal of Clinical Endocrinology and Metabolism, July 2011 jc.2011-0435

Red Meat Consumption and Mortality

The study conducted by Pan et al., from more than 120,000 people suggests that a higher intake of red meat was associated with a significantly elevated risk of total, cardiovascular disease, and cancer mortality.

The data from two prospective cohort studies among 37,698 men between 1986 and 2008 and 83,644 women between 1980 and 2008 were analyzed by Harvard researchers. Researchers documented 23,926 deaths, including 5,910 from cardiovascular disease and 9,464 from cancer during the follow up. Study estimated that substitutions of 1 serving per day of red meat for 1 serving per day of other foods i:e; fish, poultry, nuts, legumes, low-fat dairy, and whole grains were associated with a 7% to 19% lower mortality risk. The findings suggest addition of an extra portion of unprocessed red meat to an individual’s daily diet would increase the risk of death by 13%, risk of fatal cardiovascular disease by 18% and risk of cancer mortality by 10%. The figures for adding an extra portion of processed meat to an individual’s daily diet were higher than unprocessed red meat (20% for overall mortality; 21% for death from heart problems and 16% for cancer mortality).

How reliable are findings? This study is one of the first large-scale prospective longitudinal studies showing that consumption of both processed and unprocessed red meat is associated with an increased risk of mortality. The data analyzed were from men and women who were free of cardiovascular disease (CVD) and cancer at baseline and validated food frequency questionnaires updated every 4 years were used to assess their diet. Additional studies by Pan et al., explains that red meat consumption is also associated with an increased risk of type 2 diabetes mellitus.

The findings suggest substitution of fish, poultry, nuts, legumes, low-fat dairy products and whole grains for red meat significantly lowers risk of mortality.

If you eat meat daily do not panic… red meats can still be eaten as part of a balanced diet. The use of healthier cooking methods such as grilling, intake of red meat in moderation and choice of leaner cuts can protect your health. Substituting processed meats like bacon, ham, sausages or burgers, munched several times a week for other protein sources such as fish, poultry, beans or lentils can be a smart and wise option.

Reference: Pan A, Sun Q, Bernstein AM; et al. Red meat consumption and mortality: results from 2 prospective cohort studies [published online March 12, 2012]. Arch Intern Med. doi:10.1001/archinternmed.2011.2287.

Acute Respiratory Infections (ARI)

ARI ( Acute respiratory Infections) are classified as-- URTI and LRTI.

URTI ( Upper respiratory tract infections) are common cold, tonsillitis, pharyngitis, sinusitis and otitis media.

LRTI ( lower respiratory tract infections) are Epiglotitis, laryngitis, laryngotracheitis, bronchitis, bronchiolitis and pneumonia.

Escalating Sugar Consumption

The rise in consumption of sugar has tripled Worldwide in the past 50 years (BBC, Health). It is an alarming health issue around the world. Excessive consumption of sugar in diet has been linked to Obesity, high blood pressure and diabetes. The Obesity epidemic has become rampant in the United States. Obesity is not just prevalent in adult but also among children. It is now considered National Health crises. Hereditary and medical conditions aside, the cause of epidemic can be blamed to the American way of life. Sedentary lifestyle, easy availability and affordability of high caloric food rich in sugar, fat etc has taken toll over the health of individuals. The sugar consumption can be quite addictive, thus the amount of sugar in diet is a concern. US health experts (BBC, health) are now proposing policies to tax for added sugar and sweeteners. However, to build a realistic approach only demonizing sugary food may not be helpful for promoting healthy diet. It would be prudent to provide subsidies for fruits and vegetables and tax certain food products (fat, sugar etc). The affordability of fruit and vegetables would promote/encourage healthy diets.

The balanced diet is a key to good health. Health lifestyle includes plenty of physical activity; exploring the world of fruits and vegetables and avoiding high caloric/fatty food.