(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying there. You can subscribe here to get the newsletter in your inbox.)
The past week has brought non communicable diseases back into the forefront with The Lancet leading, nose ahead. No doubt, research articles are constantly being published in peer-reviewed journals, on a range of subjects. But when the journal decides to convert a subject into a series, then, by that very act, raises the profile of the condition that it wants to highlight, with the possibility to impact policy in a meaningful way, if the experts in the countries, soldier on with the evidence provided with governments of their own nations.
This one is significant also in the sense that it has advanced the oft ignored aspect of women’s health. Often sufficient attention is not paid to addressing health issues that arise in women, as a consequence of their gender, fund allocation is not commensurate and there is a tendency to shovel these issues to the back burner, both by patients and doctors. The Lancet’s series on gestational diabetes (GDM), coming soon after a similar series on Menopause, hit the right buttons in raising the profile of both these conditions. I write on the broad outlines of the series, here: A playbook to handle gestational diabetes better. Gestational diabetes is hyperglycaemia or high blood sugar levels first diagnosed during pregnancy. A common medical disorder in pregnancy, it reportedly has a global prevalence of 14%. The series in the journal offers insights and evidence into pathophysiology, screening, management, and prevention, besides suggesting new models of care that could protect both women and their children. Most importantly, it brings into play the crucial intergenerational nature of GDM and the impact, both short term and long term, it has on the health of the mother and the baby. The series, predictably, argues for a sustained, lifestyle based approach, modification of exercise and diet to prevent gestational diabetes, and picking up GDM early in the pregnancy.
Another paper in The Lancet Endocrinology and Diabetes highlighted the same: testing for GDM early in women, but also went on to suggest a simple test that would make it easy to screen pregnant women, universally. While the usual Oral Glucose Tolerance Test is the gold standard for detecting diabetes, it means consuming a concentrated glucose solution while fasting. And then staying on at a health centre to do a post prandial test, 2-3 hours later. Instead they recommended doing a HbA1c test at the point of care, with a trained health worker, and with just a drop of blood.
Another study published in The Lancet Global Health concludent that nearly 50% Indian adults insufficiently physically active. Almost 50% of adults in India engaged in insufficient levels of physical activity in 2022. Far more women in India (57%) were found to be insufficiently physically active, compared to men (42%), in line with trends across the South Asian region, the study found. The insufficient levels of physical activity in women in the region were, on average, 14% higher than those in men, it said. With the common knowledge that control of metabolic disorders hinge with a combination of diet and exercise, this must ring the alarm bells for those with a sedentary lifestyle.
This week, we also reported on a study that found rising prevalence of type 2 diabetes in the young in south India. Researchers found that there was a higher percentage increase in the prevalence of type 2 diabetes among younger individuals than in older individuals in southern India over a period of 10 years. Obesity and family history of diabetes were found to be the primary contributing factors for the rise in prevalence.
Let’s also highlight Alice Bullas’ story on whether the BMI is viable any more: Should we ditch BMI and use the ‘body roundness index’ instead? While the BMI, with its simple formula that can be worked out mentally, has been the go-to measure for estimating health, now health experts believe BMI has significant limitations, particularly for children and young people (whose body fat levels change as they grow), athletic people (who have high levels of muscle mass) and people from ethnic minority groups (who may develop health problems at lower body fat levels). But a recent study suggests that instead of BMI, we should be using something called body roundness index (BRI) to get a more accurate picture of a person’s body fat levels and predict health risk. BRI was developed by U.S. researchers in 2013 in response to criticisms of BMI. Instead of looking at height and weight, BRI mathematically quantifies body fat levels by looking at height and waist circumference instead. This provides a value typically ranging from one to 20. It is the lowest and highest values that suggest the highest health risk.
Even when we turn the spotlight on non communicable diseases, we are cognisant of the daily threat that infectious diseases still pose to the world. We are also concerned particularly for the position in India, as it is, strapped for funding for research and diagnostic testing, overwhelmed by the sheer number of people. Close to 677 million people in India required treatment against tropical diseases such as dengue, chikungunya, and snakebite envenoming in 2021, yet global research about these ailments continues to be heavily underfunded compared to illnesses such as HIV/AIDS. These diseases are termed as Neglected Tropical Diseases (NTDs) by the World Health Organization (WHO), according to this article by The Hindu Data team. The affected populations are typically among the poorest in the world. These diseases contribute to a cycle of poverty, as they cause long-term disability, social stigma, and economic burden, which in turn hinders economic development and attracts less commercial investment in treatments and research. They also lead to other health problems such as anaemia, blindness, chronic pain, infertility and disfigurement.
Here, Bani Jolly and Vinod Scaria write about how India lacks diagnostic tests for emerging infectious diseases, pegging it on the recent detection of Zika in Pune . The authors say: India’s lack of significant Zika surveillance means we might never fully understand its spread. In March 2023, CDSCO, India’s apex organisation for diagnostic approvals, confirmed that there is no approved diagnostic test for Zika. This limitation hinders our ability to diagnose Zika, relying only on classical symptoms and high clinical suspicion, making it complex as we see a concurrent upsurge in dengue cases across the country. Surveillance by ICMR on Aedes mosquitoes showed Zika virus positivity following human cases, indicating that many cases are likely being missed. They recommend: decentralising testing facilities particularly at the district and sub-district levels, developing accessible and affordable diagnostic tests for Zika, Nipah, avian influenza, and many more emerging infectious diseases.
Jacob Koshy records an interesting epidemiological phenomenon: A study recently showed that Endemic dengue may have helped stem severity of early COVID wave in India. The study was published in Journal of Medical Virology this week, suggested that the antibodies following a dengue infection were able to ‘neutralise’ coronavirus. The researchers hypothesised that the presence of antibodies to SARS-CoV-2 might decrease the severity of dengue. Larger multicentric clinical studies or population data from dengue endemic regions might help in better understanding of such cross play.
Some interesting pieces on brain power and what it really means for humans were published this week. In Sayantan Datta’s piece, he asks Could the key to how good we are at maths be hidden in our brains? In a study published in the journal Science Advances in May, researchers at Stanford University reported finding a relationship between school students’ performance in mathematical tests and their brain anatomy. The authors also identified genes whose expression correlated, they said, with the students’ ability to do mathematics. These correlations could be used to predict how much a student’s mathematical proficiency might improve with tuition, the authors added. The findings have predictably kicked up a storm, but it is important to state that neuroscientists and education researchers caution against reducing complex human abilities to biological readouts. Click on the link to read more.
Karthik Vinod writes on the Project Prakash study: Brains that don’t see in greyscale first over-rely on colours. The photosensitive cone cells in the child’s eyes don’t mature until they’re around four months old. In this time, the brain uses other visual cues to make sense of the world. In May, a team of Indian and U.S. researchers reported in the journal Science that this delay in developing colour vision is actually important for overall vision development. This study develops further on the concept.
Before we wind this up, let’s not miss this very significant development in the United States. Finally, U.S. Surgeon General Dr. Vivek Murthy declares gun violence a public health emergency. The advisory issued by Dr. Vivek Murthy, the nation’s top doctor, came as the U.S. grappled with another summer weekend marked by mass shootings that left dozens of people dead or wounded. To drive down gun deaths, Dr. Murthy calls on the U.S. to ban automatic rifles, introduce universal background checks for purchasing guns, regulate the industry, pass laws that would restrict their use in public spaces and penalise people who fail to safely store their weapons. Now, over to the Congress, that already has these facts in hand, and yet has been reluctant to legislate on it.
For the tailpiece for the week, we have a juicy tidbit from genetics, in science/health terms: D.P. Kasbekar writes on the study that finds gene mutation that turns familiar faces into strangers. It is the MCTP2 gene that we must thank for our ability to recognise faces and people. According to research published in this month’s issue of the journal Genetics, by researchers led by Ye Rao of Capital Medical University, Beijing, when this gene is mutated the ability to recognise faces is severely impaired. Individuals with the misfortune of carrying the mutant gene took much longer than is socially acceptable to recognise people with whom they were expected to be familiar — such as spouses, siblings, and children — while they confused strangers with familiar people. Intrigued? Read on, at the link.
This week, we give you explainers on NEET and the Covaxin IPR tussle.
What was the tussle over Covaxin IPR?
Rajeev Kumar indicates how we should be preventing another NEET fiasco
Jayanth R. records the trials and tribulations of students: Write NEET and repeat: The struggle to get a seat in a medical college
Heard of informed consent? Here is Christianez Ratna Kiruba’s primer: Healthcare providers need to pay greater attention to informed consent
TV Padma on what ‘Multi-omics’ is and how it is changing how India spots and treats TB, cancers
If you have a few moments extra, also browse through the following links:
Maitri Porecha reports: NEET re-test result published; all candidates get new ranks
Amit Behlari writes: CBI to seek custody of all accused in NEET paper leak case
IIT Bombay study suggests sustainable waste disposal in the healthcare sector
For many more health stories, head to our health page.
