Chronic kidney disease of uncertain etiology in agricultural communities

A new form of nephropathy is emerging in poor agricultural communities in developing countries. Chronic kidney disease of uncertain etiology (CKDu) is not attributable to risk factors such as diabetes or hypertension and has particularly targeted young men who work in the fields in Costa Rica, Egypt, El Salvador, India, Mexico, Nicaragua and Sri Lanka.

The New York Times and National Public Radio have covered CKDu in the past couple of weeks.

MEDICC Review has dedicated its April 2014 issue to this topic. Contributing authors from seven countries—including El Salvador’s Minister of Health and the president of the International Society of Nephrology—examine the global reach of CKDu and its epidemiological challenges, as well as the role of nontraditional risk factors and social determinants. All full-text articles are available free online, open access.

How the food industry misleads consumers on sugar

The food industry uses misleading marketing and industry-supported interest groups to obscure the health consequences of added sugar in their products, according to a new report, Sugar-Coating Science: How the Food Industry Misleads Consumers on Sugar, from the Center for Science and Democracy at the Union of Concerned Scientists.

“Companies are going out of their way to promote products with added sugar in them as healthier than they really are,” said Deborah Bailin, lead author. “In many cases, they’re adding sugar to otherwise healthy foods and misleading customers about it. It’s not just soda and snacks, either. Added sugar is in everything from bread to salad dressing and even frozen dinners.”

Medical researchers have linked sugar overconsumption to diabetes, cardiovascular disease, and hypertension. Despite these dangers, companies advertise products with added sugar using healthy-sounding language. For instance, Apple Cinnamon Cheerios are marketed as “whole grain,” which they are, but the product also contains 10 grams of sugar—10 times the amount in General Mills’ regular Cheerios.

Since 1970, average daily U.S. sugar consumption has increased from 74.7 grams to 82.1 grams (20 teaspoons). That is more than double the U.S. Department of Agriculture’s dietary guideline recommendation of no more than 42 grams of sugar a day. The report documents that eating just a few sugar-added products during the day could easily cause someone to exceed the recommendation level.

The food industry spends nearly $7 billion annually advertising its products. About a quarter of its spending is directed at youth advertising and sugar-heavy products make up the bulk of that spending. GoGurt yogurt, for instance, contains large amounts of added sugar, but has been advertised as healthy because it is free of “high fructose corn syrup.” The report also tracks misleading marketing campaigns for sugar-added products that have been specifically directed at women, minorities and low-income consumers.

Food industry-supported interest groups also play a significant role in misinforming the public, the report finds. Court documents recently revealed that the Corn Refiners Association (CRA) paid Berman and Company to run a misleading ad campaign through the Center for Consumer Freedom, a nonprofit run by Berman and Company’s founder. The ads conveyed the message that all sugars—whether from corn, cane, and beets—are “natural” and pose no health concerns. This message is misleading, the report says, because it distracts people from the risks associated with over-consuming sugar in any form. In internal emails, CRA’s then-president Audrae Erickson counseled colleagues to deny that CRA was financing the campaign.

The report makes the following recommendations in order to hold the food industry and its interest groups accountable for their efforts to obscure the science on sugar and its detrimental health effects:

• The media should publicly call out sugar interests’ misstatements.
• Scientific experts should disclose all real or perceived conflicts of interest.
• Investors and citizens should pressure companies to align their public messaging with science and to cease funding to trade and front groups that spread misinformation.
• U.S. Congress should restore the Federal Trade Commission and Federal Communications Commission to their full capacity to regulate marketing to children so that the agencies can regulate youth-targeted marketing.
• The U.S. Food and Drug Administration should implement a strong rule requiring the labeling of added sugar in nutrition labels as the agency announced it intends to do.
• Federal, state, and local health agencies should develop aggressive public information campaigns to emphasize the scientific evidence demonstrating sugar’s health impacts and counter the misinformation from sugar interests.

The report is being released at the Science, Democracy, and a Healthy Food Policy forum on integrating public health science into U.S. food policy, sponsored by Union of Concerned Scientists and the University of Minnesota’s School of Public Health.

Citation:
1. Bailin D, Goldman G, Phartiyal P. Sugar-Coating Science: How the Food Industry Misleads Consumers on Sugar. Cambridge, Mass.: Union of Concerned Scientists, 2014.

Live broadcast of Global Cancer Care symposium, 8 February 2014

The Global Oncology Initiative is hosting a symposium, Global Cancer Care: Challenges and Opportunities, on Saturday, 8 February, from 8:00 a.m – 6:00 p.m EST.

A live broadcast will be available on the symposium page.

Symposium topics include:

• Burden of cancer in low- and middle-income countries
• Barriers to cancer therapies in low-resource settings
• Innovative solutions to improve access to cancer care

Keynote presenters include:

• Thomas Gross, MD, PhD, deputy director of science, NCI Center for Global Health
• Rifat Atun, MBBS, MBA, professor of international health management, Imperial College London
• Paul Farmer, MD, PhD, professor of global health and social medicine, Harvard Medical School and co-founder, Partners in Health

Online participation is encouraged. Presenters will answer questions submitted electronically or via social media. Questions may be submitted by using Twitter hashtag #askGlobalOnc, or sending email to studentsforgo@gmail.com.

Follow Global Oncology on Twitter (@GlobalOnc) and Facebook.

The Global Oncology Initiative is an academic and community-­based organization based in Boston, Massachusetts, USA, leading efforts in global oncology and working to improve cancer care and research in resource-sensitive settings.

Investing in fruits, vegetables can save lives, reduce health care costs

Increasing the consumption of fruits and vegetables could save more than 100,000 lives and $17 billion in health care costs from heart disease each year in the United States, according to a new report by the Union of Concerned Scientists.

The report, The $11 Trillion Dollar Reward, explains that better federal agricultural policies, designed to encourage production of healthy food instead of processed junk foods, will help reap those benefits.

If Americans consumed just one additional serving of fruits or vegetables a day, the nation would save $5 billion in health care expenditures and prevent 30,301 heart disease and stroke deaths annually. And if Americans were to go a step further and eat a full 2.5 cups of vegetables and two cups of fruit daily, as recommended by federal dietary guidelines, it could prevent 127,261 deaths each year and save $17 billion in medical costs. The economic value of the lives saved from cardiovascular diseases is an astounding $11 trillion, according to the report.

The report researchers advocate for cost-effective policies that increase access to and reduce the cost of domestically grown fruits and vegetables for consumers, especially for low-income consumers who are hardest hit by cardiovascular disease and other diet-related illnesses. Low-income neighborhoods–where some 30 million Americans reside–are often far from grocery stores and other sources of fresh produce, hindering access.

Current federal agricultural policies channel taxpayer dollars into subsidies for commodity crops, such as corn and soybeans, which are used as feed for livestock, biofuels and as processed food ingredients. These policies offer few incentives for farmers to grow fruits and vegetables–effectively discouraging production of the very foods federal dietary guidelines recommend.

A three-minute video produced by UCS summarizes how we can achieve an $11 trillion reward through forward-looking agricultural policies.

Citation:
1. O’Hara JK. The $11 Trillion Reward: How Simple Dietary Changes Can Save Lives and Money, and How We Get There. Cambridge, Mass.: Union of Concerned Scientists, 2013.

Physical activity recommendations for children

Physical activity recommendations in early childhood should be a focus of future cardiovascular disease prevention efforts, according to a study of 3,000 children age 2-9 years from eight European countries.

The age and sex of the children are important factors in determining the right physical activity requirements. Boys age six years or younger need at least 60 minutes of moderate-to-vigorous physical activity per day, whereas boys age 6-9 years need at least 80 minutes. Girls in either age group need approximately 15 minutes less. Recommendations should also include 20 minutes of vigorous physical activity per day in all children.

Clinicians should avoid using generalized physical activity guidelines and evaluate children at risk of cardiovascular disease on a case-by-case basis, the researchers said.

Citation:
1. Jiménez-Pavón D, Konstabel K, Bergman P, et al. Physical activity and clustered cardiovascular disease risk factors in young children: a cross-sectional study (the IDEFICS study). BMC Medicine 2013; 11: 172. (open access)
2. McMurray RG. Insights into physical activity and cardiovascular disease risk in young children: IDEFICS study. BMC Medicine 2013; 11: 173. (open access)

Open access textbook on diabetes public health

Diabetes Public Health: From Data to Policy is now available open access as a Google eBook. This book provides effective approaches to prevent and manage diabetes through the practice of public health. It focuses on diabetes control in the United States and North America, and it is recommended for public health practitioners and researchers and anyone involved in health policy, administration and management.

Citation:
1. Narayan KMV, Williams D, Gregg EW, Cowie CC. Diabetes Public Health: From Data to Policy. New York: Oxford University Press, 2011.

World Health Statistics 2012

World Health Statistics 2012 is the World Health Organization’s annual report of health-related data from all 194 WHO member states. The report includes a summary of the progress made towards achieving the health-related Millennium Development Goals and associated targets. This year, it also includes highlight summaries on the topics of noncommunicable diseases, universal health coverage and civil registration coverage.

Select data from the report:

• Measles deaths declined by 74% between 2000 and 2010.
• In 2010, 85% of children age 12-23 months worldwide were immunized against measles.
• Hypertension is considered directly responsible for 7.5 million deaths in 2004–about 12.8% of all global deaths.
• In Africa, more than one third of people are estimated to have high blood pressure and this condition is increasing.
• Globally, 2.8 million people die each year as a result of being overweight or obese.
• Worldwide prevalence of obesity almost doubled between 1980 and 2008.
• In 2008, 10% of men and 14% of women (half a billion people) in the world were obese.

The report is available in English, French and Spanish.

Citation:
1. World Health Organization. World Health Statistics 2012. Geneva: WHO, 2012.

Chronic care integration for NCDs

Partners in Health is making available the Guide to Chronic Care Integration for Endemic Non-communicable Diseases. This guide is for district-level health care providers and policy makers designing a health system for care of non-communicable diseases (NCDs) in rural Rwanda and other very low-income populations.

The guide focuses on NCDs such as cardiovascular diseases, kidney disease, diabetes, hypertension, rheumatic heart disease, and respiratory diseases. It also covers the role of community health workers, family planning, mental health and social services in the treatment of chronic disease.

Citation:
1. Bukhman G, Kidder A. The PIH Guide to Chronic Care Integration for Endemic Non-communicable Diseases. Boston: Partners in Health, 2011.

Diabetes death rates on the decline in the U.S.

Death rates among U.S. adults with diabetes has been on the decline since the late 1990s, reports a new study. The study found that between 1997 and 2006 among diabetic adults, the rate of deaths due to cardiovascular disease (CVD) declined by 40 percent and the death rate due to all causes decreased by 23 percent. There was no difference in the rates of decline between diabetic men and women.

The CVD death rate, compared with non-diabetic adults, decreased by 60 percent, while the all-cause death rate declined by 44 percent.

Although these findings are encouraging, the study points out that “diabetes prevalence is likely to rise in the future if diabetes incidence is not curtailed.”

Citation:
1. Gregg EW, Cheng YJ, Saydah S, et al. Trends in death rates among U.S. adults with and without diabetes between 1997 and 2006: findings from the National Health Interview Survey. Diabetes Care 2012; 35(6): 1252-1257. (open access)

White rice linked to 11% rise in diabetes risk

A study published in BMJ.com indicates that a higher consumption of white rice is associated with a significantly increased risk of type 2 diabetes, especially in Asian populations.

Each serving per day of white rice consumption increases the risk of diabetes by 11 percent, according to the study.

Rice provides food for more than half of the world’s population, especially those living in some of the most populous countries, such as China, India, and Japan. And white rice—which is produced through a series of mechanized processes including hulling and milling and has higher glycemic levels than whole grains—is the predominant type of rice consumed worldwide.

The high glycemic levels of white rice, in combination with dramatically decreased levels of physical activity and increased access to unhealthy foods, has led to a rise in obesity insulin resistance in Asian countries.

In addition, the study shows that even for Western populations with typically low intake levels, relatively high white rice consumption may still modestly increase risk of diabetes.

Citation:
1. Hu EA, Pan A, Malik Va, Sun Q. White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ 2012; 344: e1454. (open access)