Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries

Background Diabetes mellitus represents a substantial global health challenge, with prevalence rising in low- and middle-income countries (LMICs). Although diabetes is known to follow a socioeconomic gradient, patterns in LMICs are unclear. This study examined associations between education and diabetes, and diabetes self-management behaviours, in six LMICs. Methods Cross-sectional data for 31,780 participants from China, Ghana, India, Mexico, Russia, and South Africa from the World Health Organization Study on Global AGEing and adult health (SAGE) study were used. Participants aged ≥50 years completed face-to-face interviews between 2007 and 2010. Participants self-reported diabetes diagnosis, physical activity, sedentary time, fruit and vegetable consumption, any special diet/program for diabetes, whether they were taking insulin for diabetes and number of years of education. Height, weight, waist, and hip circumference were measured. Country-specific survey-weighted log-binomial regression models were fitted to examine associations between the number of years of education and self-reported diabetes diagnosis (primary analysis). In secondary analyses, among those with a self-reported diabetes diagnosis, generalised linear regression models were fitted to examine associations between education and i) physical activity, ii) sedentary time, iii) fruit and vegetable consumption, iv) special diet for diabetes, v) taking insulin, vi) BMI, vii) waist circumference and viii) hip circumference. Results There was strong evidence of an association between years of education and diabetes diagnosis in Ghana (RR = 1.09, 95% CI: 1.06–1.13) and India (RR = 1.09, 95% CI: 1.07–1.12) only. In India, greater years of education was associated with higher leisure physical activity, fruit and vegetable intake, rates following a special diet or taking insulin, but also higher mean BMI, waist and hip circumference. Relationships between education and self-management behaviours were rarely seen in the other countries. Conclusions Associations between education and diabetes, and behavioural self-management (India only) was more evident in the two least developed (Ghana and India) of the WHO SAGE countries, indicating increasing diabetes diagnosis with greater numbers of years of education. The lack of gradients elsewhere may reflect shifting risk from higher to lower educated populations. While there was some suggestion that self-management behaviours were greater with increased education in India, this was not observed in the other countries.

Management of psoriasis with Ayurveda Panchakarma and Manibhadragula as Shodhana Rasayana – a case report

Background Plaque Psoriasis is very embarrassing condition of skin as it produces itchy rashes and scaly lesions which may not respond well to the treatment. It can be correlated with Kitibhakushta which is one among the 18 types of Kushta (skin diseases). Several corticosteroids for skin applications are used now a day’s which gives only temporary relief. Case presentation A 36 years old moderate built male patient complains of blackish skin rashes with itching, pain and scaling all over the body for three months. Based on the symptoms, Dosha (Biological humors) involved were assessed as Kapha (binding factors) and Vata (vital force of life) and suggestive of Kitibhakushta. Diagnosis of the Plaque psoriasis was further confirmed by biopsy. Classical Kushta treatment was adopted here. As Poorvakarma (pre-operative procedures), Rukshana (Dehydrating therapy) was done and then Snehapana (intake of medicated ghee) was administered. Then classical Vamana (emetic therapy) and Virechana (purgative therapy) were performed. This took almost one month. After Samsarjana (special diet) patient was administered Manibhadragula as Shodhana Rasayana for a period of one month. Results At the end of Manibhadragula intake, remarkable changes were observed in all the symptoms. There were significant changes seen in PASI, DLQI and photographs taken before and after treatment. Conclusions Here the special mode of administration of Manibhadragula as mentioned in Ashtanga Hridaya helps for Shodhana and the Shodhana itself has Rasayana action. Drugs also have Rasayana property. This made the authors to propose a new concept called Shodhana Rasayana. Classical treatment by considering the condition of Roga (disease) and Rogi (patient) helps for management of Kushta.

PRACTICAL UTILITY OF SAMSARJANA KRAMA: A REVIEW

The Shodhana procedures are mainly divided into three phases known as Trividha Karma. Acharya Dalhana has clarified Trividha Karma in the context of Shodhana as Poorva Karma, Pradhana Karma and Paschat Karma. Samsarjana Krama is a special diet pattern which is followed as Paschat Karma after Samshodhana. After Samshodhana Karma the Atura Shareera will have reduced tolerance owing to the elimination of large quantities of Dosha and Mala from the body, leading to weakness and reduction in digestive fire. This can be corrected only by following proper Samsarjana Krama with respect to the Shuddhi attained by the Atura. Acharyas detailed the Samsarjana Krama for two Annakala with respect to the ancient time period in contrast to the present scenario, where we are following three Annakala. To get a successful result from the treatment the patient should follow all the 3 stages properly. Hence, here an attempt is made to modify the Samsarjana Krama chart for the present era with respect to classical information given by the Acharyas.

School nutrition professionals' experiences with food safety and special diets in school meals during the initial COVID-19 pandemic

Federally funded school meals can help alleviate food insecurity and meals are required to be modified when medically necessary (i.e., food allergies, special diets). The COVID-19 pandemic caused many schools across the USA to close, but schools quickly modified meal serving models. The purpose of this study was to understand how school nutrition professionals were ensuring food safety and providing special diets through these modified serving models. A survey was distributed to a convenience sample (n=504). At the time of the survey, most respondents (68.31%) had been involved in COVID-19 emergency feeding for 3-4 weeks. Results indicated that while most child nutrition professionals did not find food safety easier or more difficult during the initial onset of COVID-19, about 1/3 of respondents were not taking food temperatures during meal service and were not able to obtain the equipment necessary for holding hot foods. Most respondents (60.23%) also indicated that they were not accommodating children with special diets. From a qualitative analysis of open-ended questions relative to special diet accommodation, themes indicated participants had challenges obtaining specialty items, had little time to make accommodations, or had a limited supply from vendors to accommodate these diets. To prevent food insecurity and to maintain health during the pandemic, specific solutions for at-risk populations, like those who experience food allergies, must be considered.

Qualitative Nitrogen Malnutrition Damages Gut and Alters Microbiome in Adult Mice. A Preliminary Histopathological Study

Amino-acids (AAs) are the exclusive source of nitrogen for cells. AAs result from the breakdown of food proteins and are absorbed by mucosa of the small intestine that act as a barrier to harmful materials. The quality of food proteins may differ, since it reflects content in Essential-AAs (EAAs) and digestibility but, until now, attention was paid mainly to the interaction between indigested proteins as a whole and microbiota. The link between microbiome and quality of proteins has been poorly studied, although these metabolic interactions are becoming more significant in different illnesses. We studied the effects of a special diet containing unbalanced EAAs/Non-EAAs ratio, providing excess of Non-EAAs, on the histopathology of gut epithelium and on the microbiome in adult mice, as model of qualitative malnutrition. Excess in Non-EAAs have unfavorable quick effect on body weight, gut cells, and microbiome, promoting weakening of the intestinal barrier. Re-feeding these animals with standard diet partially reversed the body alterations. The results prove that an unbalanced EAAs/Non-EAAs ratio is primarily responsible for microbiome modifications, not vice-versa. Therefore, treating microbiota independently by treating co-existing qualitative malnutrition does not make sense. This study also provides a reproducible model of sarcopenia-wasting cachexia like the human protein malnutrition.

Assessment of the Patterns of Exercise and Diet Intake among the Pregnant and Pre-pregnant Women Reported at Gynae OPD Civil Hospital Khairpur, Sindh, Pakistan

Objectives: The objective of this study is to assess the patterns of exercise and diet intake among the pregnant and pre pregnant women visiting the Gynae OPD Civil Hospital Khairpur, Sindh, Pakistan. Methodology: This is a descriptive cross sectional study conducted at the Gynae OPD Civil Hospital Khairpur, Sindh, Pakistan, from November 2020 to January 2021. A well-structured questionnaire was introduced to collect the study data and consent was taken. Sample size was calculated by Slovin’s Formula which was 400 with 95% confidence level and 5% margin of error. Results were analyzed by using statistical package for social sciences (SPSS) software version 23. Results: Results reported that, out of 400 women, during pregnancy 304 were not having gestational diabetes, before pregnancy 348 women did not exercise. It was also found that out of 322 having normal range of Body Mass Index (BMI) during pregnancy 36 of participants performed exercise, before pregnancy 40 performed the exercise, during pregnancy 256 did the household work, during pregnancy 42 followed the special diet. Conclusion: It was concluded that women who visited the OPD do not exercise properly and do not take proper diet before and during pregnancy because of inadequate awareness of role of exercise and diet for pregnancy.

DEVELOPMENT OF THE COMPONENT COMPOSITION OF AMINO ACID MIXTURES FOR THE NUTRITION OF PATIENTS WITH PHENYLKETONURIA

According to the Ministry of Health in the Republic of Belarus in 2019, there were about 500 patients with phenylketonuria (PKU). Phenylketonuria is a hereditary disease associated with a violation of the metabolism of amino acids, in particular phenylalanine (FA). This disease is accompanied by the accumulation of phenylalanine and its toxic products in the tissues, which leads to severe damage to the central nervous system, manifested in the form of impaired mental development. Many years of world experience shows that for the treatment of such patients, a special diet is prescribed using amino acid mixtures that do not contain phenylalanine or contain it in small amounts, as well as low-protein products based on starch, which are necessary to ensure an adequate energy value of the diet. The article presents the stages of development of the component composition of domestic amino acid mixtures for the nutrition of patients with phenylketonuria, taking into account their age characteristics.

Plant Protein and Plant-Based Meat Alternatives: Consumer and Nutrition Professional Attitudes and Perceptions

Plant-based and flexitarian eating patterns are increasingly popular, and the food supply system has responded with a wide range of convenience products despite a lack of understanding regarding consumer views. The aim of this study was to explore consumer and nutrition professional (NP) perceptions and attitudes to plant protein, including plant-based meat alternatives (PBMA) within an Australian context. Using an online survey promoted via social media, 679 responses (89% completion rate), achieved an even spread across key age groups. A total of sixty percent reported following a special diet, with 25% vegan and 19% flexitarian. ‘Health’ was a key driver for diet type among the NPs (53.3%) and they were less likely to follow a special diet, while “ethical” reasons were cited by consumers (69%). Plant-based eating was considered a vegan dietary pattern and the most frequently consumed plant-based proteins were whole grains. Most (74%) had tried PBMA, but they were more frequently chosen by consumers, with burger patties then sausages and mince selected as a ‘trendy’ choice; taste was very important across both groups. Products mimicking chicken and fish were of less interest. Plant-based claims were observed by 78% but these were also of greater interest to consumers. Participants reported looking for whole ingredients and iron content and expected that both iron and vitamin B12 would be comparable to red meat. Sodium was the nutrient of greatest interest to NPs and, together, these results help inform the direction for product innovation, while also highlighting the need to assess the adequacy of the dietary pattern when promoting sustainable plant-based eating.

Familial chylomicronemia syndrome: a case report

Background Familial chylomicronemia is an extremely rare disease. Lipoprotein lipase deficiency, lipoprotein defect or lipoprotein receptor defect are the main genetic causes of familial chylomicronemia. Case presentation We report a rare case of hypertriglyceridemia which was diagnosed at 24 days after birth. A newborn south east Asian baby born for G3P2A1 mother was presented with hematuria at 24 days at the hospital. The patient's family history is significant for pink blood in an elder sibling who died within a few months of birth without a proper diagnosis. Physical examination was not significant for any findings. Urinalysis revealed numerous RBC in the urine. Blood draw to perform renal function test revealed a characteristic pink blood. Baby’s blood was normal and red in color at the time of birth. During the present visit, although most of the blood test were not able to be carried out by the regular laboratory instruments, the patient’s lipid profile was alarmingly high with triglyceride levels over 4000 mg/dL. Due to a very high triglyceride level in a neonate and a significant familial history, a genetic cause of hypertriglyceridemia is suspected. Upon diagnosis, baby was discontinued of breast feeding completely and was given a special diet devoid of triglyceride and containing medium chain fatty acid diet and was also started with fenofibrate. After a month and a half, follow up tests were conducted which showed the triglyceride level was reduced to 1300 and a reversal of the blood color from pink to red. Since the imported diet was extremely expensive for the family, the patient was put on skimmed milk with medium-chain triglyceride (MCT) oil. With 6 weeks of treatment, baby’s condition has improved and is thriving well. Conclusions Our case reports an extremely rare and fatal condition and illustrated the significance of timely diagnosis and intervention for saving the life of the baby.