Tag Archives: nutrition

In the Developing World, Diseases Defy Definition

Before last week, I thought I knew the definition of “noncommunicable disease.” Then I attended “The Long Tail of Global Health Equity: Tackling the Endemic Non-Communicable Diseases of the Bottom Billion.”

 Held on the campus of Harvard Medical School in Boston March 2nd and 3rd, the 2-day conference was sponsored by Partners In Health, an international nonprofit organization that conducts research, does advocacy, and provides direct health care services for people living in poverty around the world. The “Bottom Billion” of the meeting’s title refers to the world’s poorest people living on less than $1 per day.

 In a 2008-2013 action plan, the World Health Organization refers to “the four noncommunicable diseases – cardiovascular diseases, diabetes, cancers and chronic respiratory diseases and the four shared risk factors – tobacco use, physical inactivity, unhealthy diets and the harmful use of alcohol.” Together, these conditions account for approximately 60% of all global deaths, of which 80% occur in low- and middle-income countries. 

A cancer patient in Rwanda receives chemotherapy as her husband and physician discuss her treatment / Photo courtesy of Partners In Health

But as I learned at the conference, among the Bottom Billion, rheumatic heart disease is often the result of an untreated streptococcal infection early in life, diabetes is frequently associated with malnutrition rather than over-nourishment, and cervical cancer due to human papillomavirus is far more common than in the developed world, where women routinely receive PAP screenings and a vaccine can now also prevent the infection.   

And most startling to me: Among the world’s poorest, smoking is not the most common cause of chronic obstructive pulmonary disease. Cooking with biomass fuels is.   

Individually, these and other so-called “endemic NCDs” including Burkitt’s lymphoma, sickle cell disease, and tropical diseases are far less common than those within the WHO’s “four-by-four” definition. But together, that “long tail” of chronic conditions contributes to a great deal of suffering. 

In May 2010, the United Nations announced that it would hold a high-level meeting on NCDs in 2011, now set for September 19-20. It will be only the 29th such meeting that the UN has ever held (formerly called “special sessions“), and just the second pertaining specifically to a health issue. The first one, the 2001 Summit on HIV/AIDS, is credited with focusing global attention and obtaining public and private funding for that cause. 

Speakers at the Partners In Health meeting stressed that the NCD movement should not be undertaken as an “us against them” competition with infectious disease for scarce resources. In a statement that will be presented to the heads of government at the UN summit, the group called instead for “strengthening and adjusting health systems to address the prevention, treatment, and care of NCDs, particularly at the primary health care level.”

—Miriam E. Tucker (@MiriamETucker on Twitter)


Filed under Alternative and Complementary Medicine, Cardiovascular Medicine, Dermatology, Endocrinology, Diabetes, and Metabolism, Family Medicine, Gastroenterology, Health Policy, Hematology, IMNG, Infectious Diseases, Internal Medicine, Neurology and Neurological Surgery, Obstetrics and Gynecology, Oncology, Pediatrics, Primary care, Pulmonary Diseases and Sleep Medicine, Uncategorized

Getting Kids HEALTHY

Thank God – or school administrators, or Dr. Gary Foster, or kids who just want to have fun – thank anyone you want… but there’s finally some good news about childhood obesity. It came on June 27, at the annual meeting of the American Diabetes Association

The Move It Kids demonstrate fun fitness. By Flickr user nutrition educator.

 The results of the three-year HEALTHY Study are in, and while they might not be exactly what researchers hoped for, they’re plenty good. A three-pronged middle school program that improved food in schools, jacked up gym classes, and made it “cool” to be healthy, helped husky 6th-graders slim down by the time they were headed off to high school.  

Technically, the study didn’t succeed – that is, it did not meet the primary endpoint of decreasing the prevalence of a combination of overweight and obesity at target schools more than control schools. But by the end of the intervention, HEALTHY schools did have fewer kids with extremely high waist circumference, and fewer with a body mass index above the 95th percentile.  

The program seemed to work best in the kids who were already overweight or obese as 6th-graders. They were 21% less likely to be overweight or obese in 8th grade than students at the control schools. And they had a trend – though not a significant difference toward a greater reduction in the BMI z-score  by grade eight.  

Perhaps the best news in the study was its “failed” primary endpoint: By the end of the study both intervention and control schools saw significant decreases of 4% in the prevalence of kids who were overweight or obese. It’s not entirely clear why, but at a press briefing, Dr. Foster, a Temple University endocrinologist, suggested a few possibilities.  

The control schools had the same enrollment procedure as the intervention schools: All the 6th-graders had a health screening that included weight, blood pressure, a lipid panel, and insulin and fasting glucose levels. All the parents got a “health report card” describing their child’s status and suggesting a doctor visit if indicated. That might have been enough to stimulate some family changes that helped children shed pounds.  

Just as likely, he suggested, are societal trends. Maybe word of the looming avalanche of obesity-related diabetes, cancers, and cardiovascular disasters has finally penetrated the cacophony of advertisements suggesting that kids can live off the “Children’s Menu” diet – chicken fingers, french fries, and a soda.  

Whatever the reason, I’m thrilled: Last year, my son wanted to celebrate  his 13th birthday by taking some buddies to a theme park . Two of them — one “husky” and one frankly huge —  couldn’t take the strain of walking around a slightly hilly park on a warm late-April day. The bigger one ended up in the nurse’s station for 4 hours with a splitting headache and an upset stomach.  

It was a lesson learned for my son, though. He has moderated his own diet noticeably since then, referring several times to how sad it was that his lifelong, overweight friend couldn’t keep up, even in the race to have fun. 

— Michele G. Sullivan (on Twitter @MGsullivan)

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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, IMNG, Pediatrics, Primary care, Uncategorized

A Giant of Medicine

At a meeting on cardiovascular disease epidemiology and nutrition, I was fortunate to hear a lecture by Dr.  Jeremiah Stamler, a pioneer in research connecting diet with cardiovascular disease.

Dr. Jeremiah Stamler

Photo credit: JAMA/Jim Ziv

Dr. Stamler, now 90 years old, is a diminutive man who became a giant in medicine. He was among the first to research and champion the idea that the societial impact of cardiovascular disease can be halted by preventive medicine, a field that he essentially invented.

He gave a fascinating talk on the Mediterranean eating style, a diet that appears to be effective in preventing heart disease. Sadly, in the 30 years since the association was noticed, Italians and Greeks appear to be learning some bad habits from Americans.

Although somewhat frail and walking with a cane (the consequence of joint damage from running track during his younger years, according to former employee Laura Newman), Dr. Stamler is still sharp as a tack. He’s the recent recipient of a brand new R01 research grant from the National Institutes of Health, and he’s just applied for another. He opened his talk by observing, “When Mozart was my age, he’d been dead for 50 years.”

The next day Dr. Stamler presided over a session including talks by five young investigators presenting their research and competing for the Jeremiah and Rose Stamler Research Awards for New Investigators. I found it inspirational to watch him listen to those talks, taking copious notes, and asking insightful questions of each speaker.

Dr, Stamler is clearly not just an advocate for preventive medicine. He’s a living advertisement for its efficacy.

I think I’ll have pasta e fagioli and one glass of red wine for dinner.

—Bob Finn (on Twitter @bobfinn)
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Filed under Cardiovascular Medicine, IMNG

Milk: It Does A Study Good

From the annual meeting of the American College of Nutrition, Arlington, Va.

As we all know, it’s essential to include disclosure information in our medical news stories. And sometimes the choices of news presented at a meeting are influenced by sponsors, too. I wasn’t shocked, but I was surprised that each and every symposium at the annual meeting of the American College of Nutrition was sponsored by multiple nutrition-oriented companies.

This was not a huge meeting, and the most clinically interesting material that our physician readers might enjoy was in the symposium that was sponsored by the National Dairy Council. Although the program says that (for the most part) the presentations themselves were not sponsored, when I looked into it I found that several of the presenters also had dairy council ties. The themes of the presentations were, guess what? Consuming more dairy is good!  The sponsorship doesn’t mean that the studies aren’t valid, but it’s another example of what to remember to mention in terms of disclosures–be mindful of symposium or section sponsorships as well as sponsorships from a specific study.

The National Dairy Council is interested in promoting dairy, but their claims about dairy’s benefits aren’t unfounded. There is a growing body of evidence for the benefits of including plenty of dairy in your diet. In fact, several of the presentations were literature reviews that included non-sponsored studies that showed associations between health benefits and dairy consumption.  I heard today that the American Academy of Pediatrics is recommending increased amounts of vitamin D for children with the goal of preventing disease later in life, and guess how kids can get more vitamin D? From dairy products.  For more information about dairy and health, and for the latest from the AAP about vitamin D, check out nationaldairycouncil.org and aap.org.

—Heidi Splete

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Filed under Family Medicine, Pediatrics