Chronic kidney disease of uncertain etiology in agricultural communities

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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.

Chronic care integration for NCDs

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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.

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

Effective control of high cholesterol remains low worldwide

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The percentage of people with high cholesterol who are effectively treated remains small in selected high- and middle-income countries, according to a World Health Organization study. Many of those affected are unaware of their condition. Lowering total serum cholesterol levels is an ideal strategy for reducing the burden of cardiovascular disease.

The study analyzed data sampling close to 80,000 adults age 40-79 years from England, Germany, Japan, Jordan, Mexico, Scotland, Thailand and the United States. The proportion of undiagnosed individuals was highest in Thailand (78 percent) and lowest in the United States (16 percent). The fraction diagnosed but untreated ranged from nine percent in Thailand to 53 percent in Japan. The proportion being treated who had attained evidence of control ranged from four percent in Germany to 58 percent in Mexico. Time series estimates showed improved control of high total serum cholesterol over the past two decades in England and the United States.

“These findings support the growing recognition that cardiovascular diseases are not merely ‘diseases of affluence’ and that some middle-income countries are beginning to face a double burden of both chronic and communicable diseases,” the study said.

The study recommended that programs designed to achieve higher detection and control of high blood cholesterol should be developed and implemented. Dried blood spot technology offers a new and affordable approach to screening in low-income settings. At the same time, better chronic disease surveillance is needed to monitor and guide these programs.

“Untreated high blood cholesterol represents a missed opportunity in the face of a global epidemic of chronic diseases,” the study concluded.

1. Roth GA, Fihn SD, Mokdad AH, et al. High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries. Bulletin of the World Health Organization 2011; 89: 92-101. (open access)

BMI and risk of death among Chinese Singaporeans

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Researchers in Singapore conducted a study to determine the optimal body mass index (BMI) range in relation to risk of death among Asians. The 51,250 study participants were middle-aged or older (age 45-74 years) men and women of Chinese decent living in Singapore.

The risk of death was higher among those who were either underweight (BMI of 18.5 or under) or obese (BMI of 27.5 or above). Regardless of age or BMI, smoking considerably increased the rate of mortality and modified the association between BMI and death. The most favorable range of BMI for mortality rates and risk in non-smoking persons younger than age 65 years was 18.5–21.4, and for non-smoking persons age 65 and older was 21.5–24.4.

“Our findings contribute to the science behind public health considerations on the appropriate and optimal range of relative weight in some Asian populations where a higher proportion of BMI values fall in a lower range compared to Western populations,” the study concluded.

1. Odegaard AO, Pereira MA, Koh W-P, et al. BMI, all-cause and cause-specific mortality in Chinese Singaporean men and women: the Singapore Chinese Health Study. PLoS ONE 5(11): e14000. (open access)

The Lancet: Chronic Diseases and Development

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The Lancet has released a Series of papers in preparation for the United Nation’s General Assembly meeting on chronic non-communicable diseases scheduled for September 2011. These papers cover a range of diseases–cardiovascular disease, diabetes, cancer, and chronic obstructive respiratory diseases–and present strategies for substantial health gains, monitoring, and scaling up of interventions.

The five Series papers and three additional commentaries are available open access. Free registration required.

Series paper titles:

  • Raising the priority of preventing chronic diseases: a political process
  • Health, agricultural, and economic effects of adoption of healthy diet recommendations
  • Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness
  • Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries
  • Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countries

The Lancet: Chronic Diseases and Development

Diabetes is a major public health problem in China

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Diabetes has become a major public health problem in China. Rapid economic growth, an increase in life expectancy and adoption of unhealthy lifestyles has contributed to the increase in diabetes among Chinese adults.

More than 92 million Chinese men and women have diabetes and 148 million have pre-diabetes, according to a study in the  New England Journal of Medicine.

The China National Diabetes and Metabolic Disorders Study is based on a nationally representative survey in which nearly 50,000 adults aged 20 years and older from 14 provinces and municipalities throughout China participated over a one-year period beginning in 2007.

Read more at Suite101.

1. Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med 2010; 362: 1090-1101. (open access)

Non-communicable disease risk factors in rural India

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India’s current epidemic of non-communicable diseases has resulted from increased urbanization, changing lifestyles and people living longer. But a study has found that non-communicable disease risk factors, including tobacco smoking and obesity, are strikingly high even among rural populations.

The study focused on rural populations because two thirds of India’s one billion people still live in rural areas. Rural populations have limited access to health care and can least afford to pay for the high treatment costs associated with chronic conditions.

The prevalence of non-communicable (NCD) risk factors was the following:

  • Tobacco use (40 percent men, four percent women)
  • Low fruit and vegetable intake (69 percent men, 75 percent women)
  • Obesity (19 percent men, 28 percent women)
  • High cholesterol (33 percent men, 35 percent women)
  • Hypertension (20 percent men, 22 percent women)
  • Diabetes (six percent men, five percent women)
  • Underweight (21 percent men, 18 percent women)


1. Kinra S, Bowen LJ, Lyngdoh T, et al. Sociodemographic patterning of non-communicable disease risk factors in rural India: a cross sectional study. BMJ 2010; 341: c4974. (open access)