Whole-of-society monitoring framework for sugar, salt, and fat consumption and noncommunicable diseases in India

Transitioning to an obese India: Demographic and structural determinants of the rapid rise in overweight incidence

India, which has long suffered from undernutrition, has seen a rapid rise in overweight incidence in the last decade and a half. These changes are characterized by significant within-country differences in overweight incidence that vary by gender and regional development levels. In this paper, we provide an integrative framework, linking the income-gradient hypothesis of obesity with biological, obesogenic, and environmental factors to provide an explanation on the emergence of within-country differences in overweight patterns. We utilize measured body mass index (BMI), along with individual- and household-level data of over 800,000 men and women surveyed in the National Family Health Surveys of 2005-06 and 2015-16 to identify correlates of within-country differences in overweight incidence. A decomposition analysis reveals that among women, in addition to increasing access to obesogenic technologies, biological factors are associated with overweight incidence. Among men, obesogenic factors related to technology use and health behaviors are associated with the rise in overweight incidence, but biological factors are not. At lower levels of regional development, overweight incidence is associated with greater access to obesogenic technology such as motorized transport, which reduces physical activity among men at higher rates than women. At higher levels of economic development, obesogenic behaviors, such as watching more television and reducing smoking, are associated with overweight incidence. Our results corroborate the call by public health experts for group-specific policies to stem the rise of overweight incidence in developing countries.

Market strategies used by processed food manufacturers to increase and consolidate their power: a systematic review and document analysis

BACKGROUND

The public health community has become increasingly critical of the role that powerful corporations play in driving unhealthy diets, one of the leading contributors to the global burden of disease. While a substantial amount of work has examined the political strategies used by dominant processed food manufacturers that undermine public health, less attention has been paid to their use of market strategies to build and consolidate power. In this light, this paper aimed to systematically review and synthesise the market strategies deployed by dominant processed food manufacturers to increase and consolidate their power.

METHODS

A systematic review and document analysis of public health, business, legal and media content databases (Scopus, Medline, ABI Inform, Business Source Complete, Thomas Reuters Westlaw, Lexis Advance, Factiva, NewsBank), and grey literature were conducted. Data extracted were analysed thematically using an approach informed by Porter's 'Five Forces' framework.

RESULTS

213 documents met inclusion criteria. The market strategies (n=21) and related practices of dominant processed food manufacturers identified in the documents were categorised into a typological framework consisting of six interconnected strategic objectives: i) reduce intense competition with equivalent sized rivals and maintaining dominance over smaller rivals; ii) raise barriers to market entry by new competitors; iii) counter the threat of market disruptors and drive dietary displacement in favour of their products; iv) increase firm buyer power over suppliers; v) increase firm seller power over retailers and distributors; and vi) leverage informational power asymmetries in relations with consumers.

CONCLUSIONS

The typological framework is well-placed to inform general and jurisdiction-specific market strategy analyses of dominant processed food manufacturers, and has the potential to assist in identifying countervailing public policies, such as those related to merger control, unfair trading practices, and public procurement, that could be used to address market-power imbalances as part of efforts to improve population diets.

Salt consumption and the risk of chronic diseases among Chinese adults in Ningbo city

Background

Chronic diseases have become one of essential public health concerns, leading causes of mortality in China. It is related to the changes in dietary pattern and dietary behavior. The objectives are to assess daily salt intake in Chinese people living in Ningbo and to examine its relationship with health outcomes.

Methods

Our study used data from health and nutrition survey in 2017. This study included 2811 adults aged 18–79 years (48% males) from urban and rural areas in Ningbo. A food frequency questionnaire together with demographic, physical and medical questionnaires was used to collect dietary intake, demographic, lifestyle and medical information. Ordinal logistic regression was used in the statistical analysis.

Results

The mean daily salt intake (13.0 g/day) of the participants was higher than the Chinese dietary reference intake (DRI, 6 g/d), which was related to higher risk of pre-hypertension and hypertension. Stratified by gender, education and lifestyle factors, daily salt intake was only significant in the blood pressure category (male: P = 0.048; less education: P = 0.003; urban: P = 0.006; no regular physical activity: P = 0.005, no regular smoking: P = 0.006). Ordinal logistic regression model shows that daily salt intake was significantly associated with higher odds of developing hypertension.

Conclusion

The daily salt intake of the majority of citizens living in Ningbo exceeded Chinese DRI and may increase the risk of hypertension. Moreover, public health intervention of salt restriction is necessarily needed for the prevention and control the ongoing epidemic of chronic diseases.

Incidence & prevalence of stroke in India: A systematic review

BACKGROUND & OBJECTIVES

There has been more than 100 per cent increase in incidence of stroke in low- and middle-income countries including India from 1970-1979 to 2000-2008. Lack of reliable reporting mechanisms, heterogeneity in methodology, study population, and small sample size in existing epidemiological studies, make an accurate estimation of stroke burden in India challenging. We conducted a systematic review of epidemiologic studies on stroke conducted in India to document the magnitude of stroke.

METHODS

All population-based, cross-sectional studies and cohort studies from India which reported the stroke incidence rate or cumulative stroke incidence and/or the prevalence of stroke in participants from any age group were included. Electronic databases (Ovid, PubMed, Medline, Embase and IndMED) were searched and studies published during 1960 to 2015 were included. A total of 3079 independent titles were identified for screening, of which 10 population-based cross-sectional studies were considered eligible for inclusion. Given the heterogeneity of the studies, meta-analysis was not carried out.

RESULTS

The cumulative incidence of stroke ranged from 105 to 152/100,000 persons per year, and the crude prevalence of stroke ranged from 44.29 to 559/100,000 persons in different parts of the country during the past decade. These values were higher than those of high-income countries.

INTERPRETATION & CONCLUSIONS

A paucity of good-quality epidemiological studies on stroke in India emphasizes the need for a coordinated effort at both the State and national level to study the burden of stroke in India. Future investment in the population-based epidemiological studies on stroke would lead to better preventive measures against stroke and better rehabilitation measures for stroke-related disabilities in the country.

Maternal high fat diet deficient in vitamin B12 influences long chain polyunsaturated fatty acid composition in rats

OBJECTIVE

In India, there is a rise in non-communicable diseases due to diets deficient in vitamin B₁₂, low in docosahexaenoic acid (DHA) and increased consumption of westernized diet. The present study aims to examine the effect of maternal high fat diet (HFD) in absence of vitamin B₁₂ on pregnancy outcome and tissue fatty acid composition in dams.

METHODS

Pregnant Wistar rats were assigned to following diets: Control (C), HFD, High fat diet supplemented with omega-3 fatty acids (HFDO), 4) High fat diet deficient in vitamin B₁₂ (HFBD), High fat deficient in vitamin B₁₂ supplemented with omega-3 fatty acids (HFBDO).

RESULTS

There was no effect on pregnancy outcome as a consequence of different dietary treatments. The levels of DHA in HFBD group were lower (p < 0.05 for both) in placenta as compared to both control and HFD groups, which were improved by omega-3 fatty acid supplementation.

CONCLUSION

This data suggests that maternal HFD (using dairy fat) did not adversely affect pregnancy outcome. However, maternal HFBD reduced levels of placental DHA. This may have implications for reduced fetal brain growth and development.

Time-constrained mother and expanding market: emerging model of under-nutrition in India

BACKGROUND

Persistent high levels of under-nutrition in India despite economic growth continue to challenge political leadership and policy makers at the highest level. The present inductive enquiry was conducted to map the perceptions of mothers and other key stakeholders, to identify emerging drivers of childhood under-nutrition.

METHODS

We conducted a multi-centric qualitative investigation in six empowered action group states of India. The study sample included 509 in-depth interviews with mothers of undernourished and normal nourished children, policy makers, district level managers, implementer and facilitators. Sixty six focus group discussions and 72 non-formal interactions were conducted in two rounds with primary caretakers of undernourished children, Anganwadi Workers and Auxiliary Nurse Midwives.

RESULTS

Based on the perceptions of the mothers and other key stakeholders, a model evolved inductively showing core themes as drivers of under-nutrition. The most forceful emerging themes were: multitasking, time constrained mother with dwindling family support; fragile food security or seasonal food paucity; child targeted market with wide availability and consumption of ready-to-eat market food items; rising non-food expenditure, in the context of rising food prices; inadequate and inappropriate feeding; delayed recognition of under-nutrition and delayed care seeking; and inadequate responsiveness of health care system and Integrated Child Development Services (ICDS). The study emphasized that the persistence of child malnutrition in India is also tied closely to the high workload and consequent time constraint of mothers who are increasingly pursuing income generating activities and enrolled in paid labour force, without robust institutional support for childcare.

CONCLUSION

The emerging framework needs to be further tested through mixed and multiple method research approaches to quantify the contribution of time limitation of the mother on the current burden of child under-nutrition.

Epidermal Grafting for Chronic Complex Wounds in India: A Case Series

BACKGROUND : In India, the high cost of medical treatments and limited resources can deter patients from receiving available care, leading to the development of chronic wounds. We evaluated the use of epidermal grafting in patients with complex, long-term chronic wounds.

METHODS

Eighteen patients with complex wounds were treated with epidermal micrografts between September 2014 and March 2015 at a state-run, community health center in Mahe, Puducherry, India. Wound re-epithelialization was monitored for up to 14 weeks. RESULTS : Comorbidities in the patient group (nine females and nine males; mean age 54.1 ± 10.8 years, range 32-70 years) included diabetes mellitus, hypertension, obesity (body mass index (BMI) >30 kg/m(2)), and peripheral vascular disease. The wound types included diabetic and nondiabetic foot, pressure, and venous leg ulcers. The average wound age prior to treatment was 36.8 ± 48.5 months (range 2-180 months) in the majority of patients. All wounds measured less than 7 cm × 7 cm. The mean time to wound epithelialization was 3.7 ± 1.8 weeks (range 2-9 weeks). The majority of wounds healed following epidermal grafting (n=16, 88.9%). One patient developed infection following removal of the dressing under non-sterile conditions against the advice of the healthcare providers. Another patient developed wound hypergranulation after grafting. Both wounds healed completely after treatment with antibiotic therapy and tissue resection, respectively. All donor sites healed without complications. CONCLUSION : In patients with small- to medium-sized chronic wounds, epidermal grafting offered a viable wound closure option for wounds requiring only the epidermal layer. Additionally, epidermal grafting was performed in the clinic without anesthesia or a surgeon, making the procedure more accessible in resource-challenged regions.

Harnessing the microRNA pathway for cardiac regeneration

Mounting evidence over the last few years has indicated that the rate of cardiomyocyte proliferation, and thus the extent of cardiac renewal, is under the control of the microRNA network. Several microRNAs (e.g. miR-1) regulate expansion of the cardiomyocyte pool and its terminal differentiation during the embryonic life; some not only promote cardiomyocyte proliferation but also their de-differentiation towards an embryonic cell phenotype (e.g. the miR-302/367 cluster); a few others are involved in the repression of cardiomyocyte proliferation occurring suddenly after birth (e.g. the miR-15 family); others again are not physiologically involved in the regulation of cardiomyocyte turnover, but nevertheless are able to promote cardiomyocyte proliferation and cardiac regeneration when delivered exogenously (e.g. miR-199a-3p). With a few exceptions, the molecular mechanisms underlying the pro-proliferative effect of these microRNAs, most of which appear to act at the level of already differentiated cardiomyocytes, remain to be thoroughly elucidated. The possibility of harnessing the miRNA network to achieve cardiac regeneration paves the way to exciting therapeutic applications. This could be achieved by either administering miRNA mimics or inhibitors, or transducing the heart with viral vectors expressing miRNA-encoding genes.

A comparison study on the prevalence of obesity and its associated factors among city, township and rural area adults in China

OBJECTIVES

To explore the association of dietary behaviour factors on obesity among city, township and rural area adults.

SETTING

A stratified cluster sampling technique was employed in the present cross-sectional study. On the basis of socioeconomic characteristics, two cities, two townships and two residential villages were randomly selected where the investigation was conducted.

PARTICIPANTS

A total of 1770 city residents, 2071 town residents and 1736 rural area residents participated in this survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

Dietary data were collected through interviews with each household member. Anthropometric values were measured. Participants with a body mass index (BMI) of ≥28.0 kg/m(2) were defined as obesity.

RESULTS

The prevalence of obesity was 10.1%, 7.3% and 6.5% among city, township and rural area adults, respectively. Correlation analysis showed that for adults living in cities, the daily intake of rice and its products, wheat flour and its products, light coloured vegetables, pickled vegetables, nut, pork and sauce was positively correlated with BMI (r=0.112, 0.084, 0.109, 0.129, 0.077, 0.078, 0.125, p<0.05), while the daily intake of tubers, dried beans, milk and dairy products was negatively correlated with BMI (r=-0.086, -0.078, -0.116, p<0.05). For township residents, the daily intake of vegetable oil, salt, chicken essence, monosodium glutamate and sauce was positively correlated with BMI (r=0.088, 0.091, 0.078, 0.087, 0.189, p<0.05). For rural area residents, the daily intake of pork, fish and shrimp, vegetable oil and salt was positively correlated with BMI (r=0.087, 0.122, 0.093, 0.112, p<0.05), while the daily intake of dark coloured vegetables was negatively correlated with BMI (r=-0.105, p<0.05).

CONCLUSIONS

The prevalence of obesity was higher among city residents than among township and rural area residents. The findings of this study indicate that demographic and dietary factors could be associated with obesity among adults. Healthy dietary behaviour should be promoted and the ongoing monitoring of population nutrition and health status remains crucially important.

Agriculture, health, and wealth convergence: bridging traditional food systems and modern agribusiness solutions

The causes of many vexing challenges facing 21st-century society are at the nexus of systems involved in agriculture, health and wealth production, consumption, and distribution. Using food as a test bed, and on the basis of emerging roadmaps that set achievable objectives over a 1- to 3-year horizon, we introduce this special feature with convergence thinking and practice at its core. Specifically, we discuss academic papers structured around four themes: (1) evidence for a need for convergence and underlying mechanisms at the individual and societal levels; (2) strategy for mainstreaming convergence as a driver of business engagement and innovation; (3) convergence in policy and governance; (4) convergence in metrics and methods. Academic papers under each theme are accompanied by a roadmap paper reporting on the current status of concrete transformative convergence-building projects associated with that theme. We believe that the insights provided by these papers have the potential to enable all actors throughout society to singly and collectively work to build supply and demand for nutritious food, in both traditional and modern food systems, while placing the burdens of malnutrition and ill health on their core strategic agendas.