Colorectal Cancer in Africa: Causes, Dietary Intervention, and Lifestyle Change

Colorectal cancer (CRC) is a menace in the global public health system. According to GLOBOCAN reports, colorectal cancer is the second most diagnosed cancer in the world with more than 1.9 million cases and 935,000 deaths in 2020 alone. Diet plays a key role in exposing humans to environmental carcinogens and anti-carcinogens, consequently mitigating or aiding in the development of various cancers. CRC is most prevalent in western countries with a high intake of saturated fats, refined carbohydrates, and processed meat. CRC was an extremely rare disease in Africa some decades ago, but the situation is fast changing. The traditional African diet consists of leafy, roots and cruciferous vegetables, fruits, roots, tubers and plantains, legumes, whole grains, and spices, all of which have been shown to possess protective effects against CRC. However, the effect of urbanization has contributed to the shift of dietary choices among the African population to consuming more ultra-processed foods with high levels of unhealthy components that have originated from colorectal cancer prevalent regions. This review evaluates the current nutritional challenges of the African diet to colorectal cancer and the potential roles of the traditional African diets and lifestyle modification in the prevention and management of colorectal cancer.

Nutritional Status of Inmates in the Central Prison of Mbuji-Mayi, Democratic Republic of Congo

Background The nutritional situation in prisons of developing countries and the health status of inmates remain a major human rights concern. The objective of the study was to assess the nutritional status of inmates jailed in a prison of the Democratic Republic of Congo (DRC). Methods This cross-sectional study was conducted over a 4-month period in the Central Prison of Mbuji-Mayi, DRC. Three hundred inmates were selected according to the Malnutrition Universal Screening Tool (MUST). Severe malnutrition was defined according to Buzby index and Nutritional Risk Index (NRI). Data were analyzed by Stata™ (version12.0). Results The inmates were aged between 18 and 70 years and primarily males (88.7%). Of them, 24% were suffering from severe malnutrition and 62% of moderate malnutrition as based on the NRI. At the time of study, 88% of inmates were incarcerated for more than 6 months. Multivariate logistic regression analysis showed that factors independently associated with severe malnutrition were incarceration of more than 6 months (OR=5.1; 95% CI (1.5-17.4)), origin of food (prison vs. family or NGO) (OR=4.7; 95% CI (1.6-13.8)) presence of tuberculosis, human immunodeficiency virus and/or intestinal infections (OR=2.6; 95% CI (1.4-4.7)). Conclusions The nutritional situation in the Central Prison of Mbuji-Mayi is precarious. There is urgent need to supply enough nutrient-rich food to improve health of inmates.

The Sweet and Sour of the Sugar-Sweetened Beverage Tax

Obesity is a common and preventable Non-Communicable Disease that is of great importance. Population-based interventions are recognized to have a profound effect on improving health outcomes. One of these approaches includes the adoption of the Sugar-Sweetened Beverage (SSB) Tax. Objectives: There were three objectives, 1) Explore the associations between age, gender, nationality, and SSB consumption, 2) explore SSB consumption during Covid-19 lockdown and, 3) inform policy decision making. Methods: A cross-sectional survey in the United Arab Emirates. We performed descriptive analysis and chi-square for independence to test the difference between the expected and the observed frequencies in one or more categories. Results: Since the introduction of the SSB tax, we report no change in SSB consumption by age, gender, or nationality. Further analysis of the proportion of sugar intake per day was significant (P-value <0.001) by nationality. There was no significant change in SSB consumption by age, gender, or nationality during the Covid-19 lockdown. Further analysis within the group that reported a change in SSB consumption (80.5%) had a reduction in SSB consumption. Conclusions: Age, gender, and nationality do not significantly impact SSB consumption, or during Covid-19 lockdown; thus, we accept the Null Hypothesis. Imposing a levy on frequently consumed SSB or revisiting levy by the gram, volume, or type of added sugar (or in combination) may prove more effective in reducing SSB consumption. Further research is needed to determine the extent income and education influence SSB consumption in the UAE and the enablers and barriers associated with SSB consumption.

The Influence of Siblings on Young Children’s Understanding of Fluid Intake

Background Children need to drink enough water (1.1-1.3 litres) throughout the day to stay hydrated and for health benefits1. Wellbeing and cognitive function benefits have been identified for children who are hydrated2. Yet there is a dearth of research focusing specifically on children’s perceptions of their own fluid intake levels and who helps support them in ensuring they are drinking enough water, this is a novel area to investigate. Previous research3 identified that 44.2% of young children’s fluid intake were influenced the strongest by a family member. This paper will explore in further detail the influence of siblings on children’s fluid intake, in particular older versus younger siblings. Methods 130 children (67 girls and 63 boys, of which 45 had a younger sibling (s) and 85 having an elder sibling(s), from 4 primary schools in the South East of England, were questioned between January and April 2019 using an adapted version of Coppinger and Howells’ (2019)4 questionnaire, on their understanding of fluid intake, how much they perceived they drank and who supported them in prompting them to drink. Physical visual representations were used to aid question comprehension and to ensure the questions were appropriate for young children. The data was analysed using SPSS 24.0 using MANOVAs (P < 0.05) to consider statistical variance in gender and older sibling status. Results The most significant results were linked to elder siblings influence younger siblings in drinking too little fluids within a school day (F=0.530, p<0.05), whilst those without an elder sibling, thought they drank beyond the daily recommended guidelines and reported they drank over 2 litres. This illustrates that children misunderstand fluid intake recommendations regardless of whether they have an elder sibling or not. Children named adults, both parents and teachers as well as elder siblings as the key influencers of them drinking (F=3.67, p<0.05) and the data indicated that girls were more influenced by siblings than boys, whilst twins were not influenced by each other. Conclusion It is concluded that siblings do have an influence on the consumption of water, as siblings act as role models and other siblings follow their habits, therefore the whole family unit is important to ensure that the right fluid intake is consumed. It is recommended that further education, curriculum and community development is needed to continue to support young children’s knowledge and understanding of fluid intake.

Socio Economic Profile and Nutritional Status of the Rickshaw Pullers of Dhaka City Along with their Energy Intake Gap

Background This study focused on nutritional status of the rickshaw pullers, their dietary energy and nutrients consumption along with their energy intake gap as compared to expenditure. Methods A cross sectional study was carried out at 15 different important locations of Dhaka city during December-January 2018. In total, 670 rickshaw pullers from these locations were randomly selected. Printed predesigned and validated semi structured questionnaire was used to record necessary information. Nutritional status was determined according to Asia specific BMI cut- off values. Energy expenditure was calculated using their Basal Metabolic Rate (BMR) and Physical Activity Level (PAL) value. 24-hour dietary recall method was administered for dietary analysis. Results About 65.4% of them were found within normal BMI range. About 11.5% were underweight and about 23.1% were found having more than normal BMI. Percentage of both underweight (39.0%) and overweight (35.8%) were found higher among those who were between 25 and 35 years. Average daily dietary energy consumption was 2391 kcal and energy expenditure were found 4608 kcal. Their energy consumption was found 2217 kcal less compared to their energy expenditure. Conclusion The current study revealed the nutritional status, dietary intake of the rickshaw pullers of Dhaka city and found energy gap in their dietary intake compared to their expenditure. For their better health and nutrition outcome integrated approach should be taken by the responsible authorities.

Nutritional Status and Nutrition-Related knowledge Among Urban Adolescent Girls in Bangladesh

Background Nutritional status of adolescent girls is very crucial for their health and has a great impact on the quality of the next generation. The present study aimed to investigate the nutritional status and nutrition-related knowledge among urban adolescent girls in Bangladesh. Methods A cross-sectional study involving a total 500 of adolescent girls (aged 10-19) from four schools and colleges in Dhaka city. Socio-demographic, anthropometric and nutrition-related information was collected by semi-structured questionnaires. In addition, 24 hours food recall and food frequency questionnaire was used to assess the dietary intake. Results The ages of the early adolescent and late adolescent girls yrs (Mean ± SD) were 12±1 and 17±1 respectively. The mean (±SD) BMI of the early adolescent and late adolescent was 21.12±0.32 and 22.10±3.89 correspondingly. Among the early adolescent girls, the nutritional knowledge score was about 62% (moderate), 87% had a positive attitude and 72% had good practices in their daily lives. Whereas among the late adolescent girls, the nutritional knowledge score was about 57% (moderate), 90% showed a positive attitude and 61% had good practices. Among the subject, the average calorie intake was 1491 kcal, which was 24% lower than RDA. The Carbohydrate intake was lower than the RDA but the protein and fat intake was higher than the RDA. Conclusions The dietary intake of adolescent girls was found inadequate. Nutrition education and strong motivation can create positive changes in dietary intake. To understand the real phenomena of dietary intake of adolescent girls, further study is necessary to conduct with a large sample size.

Impact of Environmental Sanitation and Hygienic Practices on Nutritional Status of Lodha Women and Children of West Bengal, India

Aim To assess the sanitation and hygienic practices of women and its effects on the nutritional status of the mother and preschool children of the Lodha tribal community in two districts of West Bengal. Methods A cross-sectional study was conducted during November, 2014 - December, 2018 of 941 Lodha mothers and 1043 of their preschool children in Paschim Medinipur and Jhargram districts. All information was collected by using KAP questionnaire following interview and group discussion. Mother nutritional status was assessed based on body mass index (BMI) and mid upper arm circumference (MUAC). A child was classified as underweight, stunting and wasting as weight-for-age, height-for-age and weight-of -height Z-score below -2 standard deviation of WHO standard. Results This study found 35% of the households used safe drinking water. Almost 97.2% of the mother had the low hand wash score and about 67.1% of them had an average WaSH score. Overall, 41.6% and 1.6% mothers were suffered from undernutrition (BMI <18.5 kg/m2) and overweight/obesity (BMI≥25kg/m2). Whereas, 48.9% women were undernourished based on MUAC<22.0cm. Moreover, the overall prevalence of wasting, stunting and underweight of preschool children was 31.9%, 62.1% and 61.3%, respectively. The WaSH score of family was significantly associated with child stunted and underweight. Conclusion There is a good association between poor household WaSH practices with child undernutrition and morbidity. Hence, there is an urgent need to develop the comprehensive knowledge, attitude and practice (KAP) guidelines in their language to educate them about appropriate water storage, retrieval methods, sanitation and hand washing practices.

Adopting High Fat Diets for Fat Loss and Improving Brain Health.

With an increased intake of processed carbohydrates and refined sugars, the obesity rate has shot up in the past decade giving rise to mental and physical health problems. These individuals are also the most vulnerable to a number of other diseases including the current pandemic of Covid-19. This paper aims to address the knowledge gap that is required to promote a healthy lifestyle for mental and physical wellbeing. The paper also analyses a number of different studies conducted and helps in understanding obesity as a strong risk factor to various disorders. Despite constant recommendations from healthcare organisations to address the importance of weight regulation, the process to do so often remains uncertain to the general population. The paper analyses the effects of the ketogenic diet for fat loss as well as treating mental illnesses and aims to address the influence of high carbohydrate diets on mental illnesses.

Use of Microfluidic Assays to Develop Reliable and Economic Nucleic Acid Application Technologies, Employing MicroRNAs for the Diagnostic Screening of Colon Cancer in Human Stool in Low-Resource Settings

Isolation methods that employ readily-available inexpensive supplies on the open market, which are reliable, as well as economical, such as nucleic acid amplification techniques (NAAT) based on microfluidic technology in low-resource research settings (LRRS) that meets the ASSURED guidelines are essential to develop a noninvasive diagnostic colon cancer screen in stool using micro(mi)RNA molecules. A combination of a microfluidic-based MiRNA stool test with a reliable rolling circle amplification/detection method applied to the quantification of miRNA molecules, result in an affordable sensitive and specific isothermal method for the noninvasive quantitative detection of miRNAs in LRRS. Scientists and engineers have become interested in miRNAs, and they have intensified their efforts to apply emerging simple detection tools to the important bioanalytical challenge of quantifying these small 18-26 nt long molecules. Some of the proposed approaches incorporate novel material, such as simple centrifuges and methods based on microfluidic technology, while others utilize the interesting biological properties of these molecules, such as forming branched RCA structures, allowing for the detection of these biomarker molecules at an attomolar "aM" concentration level, using low cost extraction and isothermal amplification methods in LRRS. We have been interested in studying colorectal cancer (CRC) because it is the 3rd most common malignancy worldwide, and stool can be obtained noninvasively from the patients. We have focused in this research on colon cancer (CC) because it is more common in the USA than rectal cancer (RC). The innovation of our approach lies in the exploratory use of an affordable, quantitative miRNA profiling in noninvasive stool samples in LRRS, whose extracted fragile total RNA is stabilized shortly after excretion from stool by commercially available kits, so it does not ever fragment, followed by quantitative standardized analytical tests that are neither labor intensive, nor require expensive instrumentation, in order to develop apanel of novel miRNA genes for the noninvasive diagnostic screening of early left and right sporadic colon cancers, more economically, and with higher sensitivity and specificity than any other colon cancer screening test currently available on the market. To show the clinical sensitivity and specificity of the proposed quantitative miRNA test using simple methodologies in LRRS,the miRNA results are to be correlated with FOBT, colonoscopy, and pathology data. Standardization establishes test’s performance criteria (sample selection, optimal sample running conditions, preservation and storage), in order to ensure that the assay will perform the same way in any laboratory, by any trained personnel, anywhere in low-resource laboratory settings worldwide.

Clinical Evaluation of Significance of 25(Oh)D (Vitamin D) Status in Swine Flu (H1N1)

Background Since swine flu has been declared pandemic in 2009 it has become a major challenging public-health problem associated with high morbidity and mortality. 25(OH)D deficiency is also pandemic and has been reported to be clinically correlated with decreased immunity and respiratory infections. The possible role of vitamin D in infections is implied from its impact on the innate and adaptive immune responses. This study is planned to evaluate clinical significance of 25(OH)D status on course and outcome in hospitalized cases of swine flu and to compare it with normal healthy subjects living in the same vicinity to evaluate if vitamin D is having any protective effect. Material & Methods Present prospective cross-sectional study was conducted on 79 RT-PCR confirmed cases of swine flu admitted during recent epidemic. All patients were evaluated thoroughly by clinical history physical examination and laboratory investigations as per Performa and followed-up during hospital stay. 25-hydroxyvitamin D (25(OH)D) estimation was done by electro-chemiluminescent Assay in all the cases and it was also done in 36 normal healthy family members of study patients living in the same vicinity (control group). Results High prevalence (70.9%) of low (≤30ng/ml) status of 25(OH)D was observed in cases of swine flu as compared to control group. 25(OH)D status was associated with severity of illness. Mean value of 25(OH)D in mechanically ventilated patients was 9.81±6.43 while it was 22.76±11.35 ng/ml in patients who do not required ventilation (p<0.05). Mean 25(OH)D level in patients who stayed in hospital for <5 days was 28.60±8.79 ng/ml, 24.18±11.67 for 6-10 days and 8.23±2.12 for >10 days (p<0.01). Mean value of 25(OH)D in patients who died was 9.59±5.90 ng/ml as compared to 23.13±11.62 ng/ml who survived (p<0.01). Conclusion Our study suggests that 25(OH)D may have preventive role for swine flu infection. Low level of 25(OH)D is associated with high morbidity in terms of increase requirement for mechanical ventilation, multiorgan dysfunction and long duration of hospital stay. 25(OH)D deficiency is associated with high mortality in swine flu. 25(OH)D status should be given due consideration in high risk patients especially during winter season.