This document summarizes a presentation on the nutrition implications of HIV and antiretroviral therapy (ART). It reviews research showing that low nutritional status prior to starting ART is associated with increased mortality, while ART initiation enables weight gain and improved survival. Early weight gain on ART, especially for those with low baseline body mass index, predicts better outcomes. However, food insecurity is common among people living with HIV and can be a barrier to initiating and adhering to ART, with poorer treatment responses. The presentation identifies gaps in understanding how nutritional interventions may improve ART outcomes.
Metabolic syndrome and erectile dysfunctionTarek Anis
The document summarizes a presentation on metabolic syndrome in the Middle East. It discusses what metabolic syndrome is, how its diagnostic criteria and understanding have evolved over time, and its association with conditions like cardiovascular disease and erectile dysfunction. Some key points:
- Metabolic syndrome is defined as a clustering of conditions like abnormal blood glucose, dyslipidemia, obesity and high blood pressure.
- Its prevalence is increasing globally and is higher in the Middle East than Western countries, affecting over a third of populations in some Middle Eastern nations. Prevalence is higher in women.
- Metabolic syndrome is linked to a higher risk of erectile dysfunction in both men and sexual dysfunction in women. The severity of erectile and sexual
This document discusses the history and current state of diabetes in India. It notes that diabetes was first described in ancient Indian medical texts from 2500 years ago. Currently, India has the second highest number of people with diabetes worldwide at 65.1 million. By 2035, this is projected to rise to 109 million. The document outlines strategies for diabetes prevention in India, including promoting healthy lifestyles, identifying those at high risk, and delivering lifestyle interventions to those with prediabetes. Comprehensive management of diabetes involves diet, exercise, medication and self-care.
Για τις νέες προκλήσεις που αντιμετωπίζουμε έκανε λόγο ο Θόδωρος Σκυλακάκης
Στο μείζον θέμα της πρόληψης στον τομέα της υγείας αλλά και τις νέες προκλήσεις που προκύπτουν έκανε λόγο ο ευρωβουλευτής του ΕΛΚ και ιδρυτικό στέλεχος της Δημοκρατικής Συμμαχίας κ. Θόδωρος Σκυλακάκης σε εκδήλωση με θέμα
«Πρόληψη: στρατηγική επιλογή για την πολιτική δημόσιας υγείας στην Ελλάδα και την Ε.Ε.».
Σύμφωνα με τον έλληνα ευρωβουλευτή «όλοι είναι υπέρ της πρόληψης, στο τέλος όμως κανείς δεν ενδιαφέρεται να πάρει πρωτοβουλίες». Ωστόσο ο κ. Σκυλακάκης τόνισε ότι «δεν είναι ελληνικό αλλά ευρωπαϊκό φαινόμενο».
Παράλληλα έκανε λόγο για τις νέες προκλήσεις που έχουμε να αντιμετωπίσουμε όπως η γήρανση του πληθυσμού, η υπόθεση του ανθρώπινου γονιδιώματος αλλά και οι δυνατότητες που έχει το marketing στον τομέα της πρόληψης.
Όσον αφορά το ανθρώπινο γονιδίωμα (αποτελείται από το σύνολο των γονιδίων ενός οργανισμού και κατευθύνει την φυσική ανάπτυξη και την συμπεριφορά του), ο κ. Σκυλακάκης ανέφερε ότι σε 3-4 χρόνια θα υπάρχει η δυνατότητα εξέτασης γονιδιωμάτων με 100 δολάρια.
Στην εκδήλωση ήταν καλεσμένος και ο βουλευτής του ΠΑΣΟΚ και καθηγητής στο London School of Economics κ. Η. Μόσιαλος, ο οποίος όμως δεν κατάφερε να παρευρεθεί λόγω της κακοκαιρίας.
This document discusses metabolic syndrome, including its history, criteria for diagnosis, epidemiology, risk factors, complications, etiology, and prevention. Metabolic syndrome is defined as a cluster of conditions that occur together, including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The prevalence of metabolic syndrome is high worldwide and increasing, with risk factors including older age, female gender, obesity, physical inactivity, and genetic factors. Complications of metabolic syndrome include increased risk of type 2 diabetes, cardiovascular disease, and mortality. Prevention focuses on lifestyle changes like healthy diet, exercise, and weight management.
This document summarizes a review article on polycystic ovary syndrome (PCOS). PCOS is a common endocrine and metabolic disorder in premenopausal women, affecting 8-13% of reproductive-aged women. It is characterized by a combination of signs including androgen excess and ovarian dysfunction. Lifestyle management including diet and exercise is emphasized as the cornerstone of PCOS treatment by international guidelines. The review discusses the pathophysiology, symptoms, characterization and management of PCOS.
The document discusses how genetic testing and targeted therapies have revolutionized the diagnosis and treatment of breast cancer. It describes two cases of women diagnosed with breast cancer and how genetic testing identified a BRCA1 mutation in one family, allowing for increased screening and preventative options. Precision medicine through companion diagnostics now enables targeted therapies that work more precisely with less side effects compared to traditional chemotherapy.
This document discusses metabolic syndrome, its causes and consequences. Metabolic syndrome is a cluster of conditions that increases the risk of heart disease, diabetes and stroke. It is becoming more common due to lifestyle factors like poor diet, lack of exercise and obesity. Refined carbs and sugar are major contributors, comprising 80-90% of the effect. Adopting a whole foods, plant-based diet has been shown to successfully treat and reverse metabolic syndrome in many cases by promoting weight loss and improving related health markers.
Metabolic Syndrome, Diabetes, and Cardiovascular Disease ... Metabolic Synd...MedicineAndFamily
This document discusses metabolic syndrome, diabetes, and cardiovascular disease. It provides an overview of diabetes prevalence in the US and shows that diabetics are at significantly higher risk of cardiovascular events like coronary disease and stroke. It then discusses insulin resistance, the natural history of type 2 diabetes, and how obesity and insulin resistance can lead to metabolic defects and increased risk of conditions like kidney disease. Lastly, it examines the prevalence of metabolic syndrome in the US according to different definitions and shows that metabolic syndrome is associated with higher rates of cardiovascular disease and mortality.
Metabolic syndrome and erectile dysfunctionTarek Anis
The document summarizes a presentation on metabolic syndrome in the Middle East. It discusses what metabolic syndrome is, how its diagnostic criteria and understanding have evolved over time, and its association with conditions like cardiovascular disease and erectile dysfunction. Some key points:
- Metabolic syndrome is defined as a clustering of conditions like abnormal blood glucose, dyslipidemia, obesity and high blood pressure.
- Its prevalence is increasing globally and is higher in the Middle East than Western countries, affecting over a third of populations in some Middle Eastern nations. Prevalence is higher in women.
- Metabolic syndrome is linked to a higher risk of erectile dysfunction in both men and sexual dysfunction in women. The severity of erectile and sexual
This document discusses the history and current state of diabetes in India. It notes that diabetes was first described in ancient Indian medical texts from 2500 years ago. Currently, India has the second highest number of people with diabetes worldwide at 65.1 million. By 2035, this is projected to rise to 109 million. The document outlines strategies for diabetes prevention in India, including promoting healthy lifestyles, identifying those at high risk, and delivering lifestyle interventions to those with prediabetes. Comprehensive management of diabetes involves diet, exercise, medication and self-care.
Για τις νέες προκλήσεις που αντιμετωπίζουμε έκανε λόγο ο Θόδωρος Σκυλακάκης
Στο μείζον θέμα της πρόληψης στον τομέα της υγείας αλλά και τις νέες προκλήσεις που προκύπτουν έκανε λόγο ο ευρωβουλευτής του ΕΛΚ και ιδρυτικό στέλεχος της Δημοκρατικής Συμμαχίας κ. Θόδωρος Σκυλακάκης σε εκδήλωση με θέμα
«Πρόληψη: στρατηγική επιλογή για την πολιτική δημόσιας υγείας στην Ελλάδα και την Ε.Ε.».
Σύμφωνα με τον έλληνα ευρωβουλευτή «όλοι είναι υπέρ της πρόληψης, στο τέλος όμως κανείς δεν ενδιαφέρεται να πάρει πρωτοβουλίες». Ωστόσο ο κ. Σκυλακάκης τόνισε ότι «δεν είναι ελληνικό αλλά ευρωπαϊκό φαινόμενο».
Παράλληλα έκανε λόγο για τις νέες προκλήσεις που έχουμε να αντιμετωπίσουμε όπως η γήρανση του πληθυσμού, η υπόθεση του ανθρώπινου γονιδιώματος αλλά και οι δυνατότητες που έχει το marketing στον τομέα της πρόληψης.
Όσον αφορά το ανθρώπινο γονιδίωμα (αποτελείται από το σύνολο των γονιδίων ενός οργανισμού και κατευθύνει την φυσική ανάπτυξη και την συμπεριφορά του), ο κ. Σκυλακάκης ανέφερε ότι σε 3-4 χρόνια θα υπάρχει η δυνατότητα εξέτασης γονιδιωμάτων με 100 δολάρια.
Στην εκδήλωση ήταν καλεσμένος και ο βουλευτής του ΠΑΣΟΚ και καθηγητής στο London School of Economics κ. Η. Μόσιαλος, ο οποίος όμως δεν κατάφερε να παρευρεθεί λόγω της κακοκαιρίας.
This document discusses metabolic syndrome, including its history, criteria for diagnosis, epidemiology, risk factors, complications, etiology, and prevention. Metabolic syndrome is defined as a cluster of conditions that occur together, including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The prevalence of metabolic syndrome is high worldwide and increasing, with risk factors including older age, female gender, obesity, physical inactivity, and genetic factors. Complications of metabolic syndrome include increased risk of type 2 diabetes, cardiovascular disease, and mortality. Prevention focuses on lifestyle changes like healthy diet, exercise, and weight management.
This document summarizes a review article on polycystic ovary syndrome (PCOS). PCOS is a common endocrine and metabolic disorder in premenopausal women, affecting 8-13% of reproductive-aged women. It is characterized by a combination of signs including androgen excess and ovarian dysfunction. Lifestyle management including diet and exercise is emphasized as the cornerstone of PCOS treatment by international guidelines. The review discusses the pathophysiology, symptoms, characterization and management of PCOS.
The document discusses how genetic testing and targeted therapies have revolutionized the diagnosis and treatment of breast cancer. It describes two cases of women diagnosed with breast cancer and how genetic testing identified a BRCA1 mutation in one family, allowing for increased screening and preventative options. Precision medicine through companion diagnostics now enables targeted therapies that work more precisely with less side effects compared to traditional chemotherapy.
This document discusses metabolic syndrome, its causes and consequences. Metabolic syndrome is a cluster of conditions that increases the risk of heart disease, diabetes and stroke. It is becoming more common due to lifestyle factors like poor diet, lack of exercise and obesity. Refined carbs and sugar are major contributors, comprising 80-90% of the effect. Adopting a whole foods, plant-based diet has been shown to successfully treat and reverse metabolic syndrome in many cases by promoting weight loss and improving related health markers.
Metabolic Syndrome, Diabetes, and Cardiovascular Disease ... Metabolic Synd...MedicineAndFamily
This document discusses metabolic syndrome, diabetes, and cardiovascular disease. It provides an overview of diabetes prevalence in the US and shows that diabetics are at significantly higher risk of cardiovascular events like coronary disease and stroke. It then discusses insulin resistance, the natural history of type 2 diabetes, and how obesity and insulin resistance can lead to metabolic defects and increased risk of conditions like kidney disease. Lastly, it examines the prevalence of metabolic syndrome in the US according to different definitions and shows that metabolic syndrome is associated with higher rates of cardiovascular disease and mortality.
This document discusses metabolic syndrome, including its definition, causes, risk factors, prevalence in different populations, and treatment approaches. Metabolic syndrome is a cluster of conditions that increases the risk of cardiovascular disease and diabetes. It is characterized by abdominal obesity, high blood pressure, insulin resistance, and dyslipidemia. Lifestyle interventions like diet modification, increased physical activity, and weight loss are effective first-line treatments to reduce the risk factors of metabolic syndrome. The document reviews evidence on how different diets, exercises and weight management can help control metabolic syndrome.
The document discusses the history and development of exercise science as a discipline. It highlights some of the early leaders in Scandinavia and discusses seminal research findings showing the health benefits of cardiorespiratory fitness (CRF) and muscular strength. Several studies from the Aerobics Center Longitudinal Study are summarized that demonstrate the inverse associations between CRF and mortality from cardiovascular disease and other causes. Additional research is reviewed showing the benefits of exercise for chronic disease populations and older adults. The role of exercise as an evidence-based treatment for diseases like diabetes is emphasized.
1) A 46-year-old man with type 2 diabetes, hypertension, obesity, and dyslipidemia presented with erectile dysfunction. Laboratory tests confirmed metabolic syndrome and hypogonadism.
2) The patient meets criteria for metabolic syndrome according to NCEP-ATP III guidelines due to diabetes, hypertension, abdominal obesity, and low HDL. Hypogonadism was diagnosed based on low total testosterone, free testosterone, and bioavailable testosterone levels.
3) Guidelines recommend screening patients with diabetes and symptoms of hypogonadism for low testosterone. The patient should have been screened for erectile dysfunction due to his risk factors of diabetes and metabolic syndrome.
Cancer 101 provides an overview of cancer including definitions, statistics, risk factors, and lifestyle measures for prevention. It reviews that cancer is abnormal cell growth, the second leading cause of death, and risk is increased by certain lifestyle behaviors like poor nutrition, lack of exercise, stress, sleep issues, and toxic exposures. Maintaining a healthy lifestyle through diet, exercise, managing stress, adequate sleep, and avoiding toxins can help lower cancer risks.
This document discusses the link between diabetes and cancer. It notes that cancer and diabetes are diagnosed together more frequently than expected by chance. Several risk factors are shared between the two diseases, including age, diet, obesity, and lifestyle factors. The document explores how insulin and IGF-1 may influence cancer development via their effects on cell growth pathways. It reviews evidence on the effects of different diabetes medications, including some studies that found certain insulin analogs may increase cancer risk. Several cohort studies on the cancer risks of insulin glargine are also summarized.
Harnessing the Power of Nutrition to Complement Brain Tumor CareJeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at the 1st Annual Brains Matter conference (Sept 2012 in Seattle), sponsored by the Chris Elliott Foundation. Learn how nutrition can play a powerful role to influence the terrain (environment) surrounding cancer cells. Discover foods that can "talk" to your genes, suppressing oncogenes and turning on tumor suppressor genes. Explore simple diet and lifestyle changes you can make to nourish your wellness when facing a brain tumor diagnosis.
Understanding how intermittent fasting may not only help weight loss but have multiple other health benefits including life prolongation, preventing cancer and dementia
Considering the mechanisms behind cancer cachexia-anorexia can inform wiser n...Jeanne M Wallace PhD
Unwanted weight loss and lack of interest in food drives many cancer patients to conventional canned nutrition formulas like Ensure, but these may actually foster the oncogenic process. This article outlines the underlying physiology of cachexia and compares various feeding formulas including holistic nutrition options.
This document outlines recommendations from the World Cancer Research Fund for reducing cancer risk through lifestyle choices. It discusses 10 main recommendations, including maintaining a healthy weight, being physically active, eating a plant-based diet with limited red meat and processed meats, limiting alcohol intake, and not smoking or chewing tobacco. The recommendations are based on extensive reviews of scientific evidence on diet, nutrition, and cancer prevention. The role of health professionals is discussed, including educating patients on following a healthy lifestyle to reduce their cancer risk and supporting cancer survivors.
Food choices can help prevent cancer and, when cancer has been diagnosed, nutrition can improve survival. These links between diet and cancer are nothing short of dramatic. And now you can learn how certain dietary patterns help people diagnosed with cancer live longer, healthier lives.
Ueda2016 metabolic syndrome in different population,which one is appropriate ...ueda2015
Metabolic syndrome is a cluster of disorders including high blood pressure, high insulin levels, excess body weight, and abnormal cholesterol that increases the risk of diseases like diabetes and heart disease. There is wide variation in the reported prevalence of metabolic syndrome across populations and definitions, and questions remain about its applicability and predictive power equally in all groups. Key determinants include obesity, especially abdominal obesity, and insulin resistance, but genetic and lifestyle factors also contribute to risk.
This document discusses cancer prevention and screening. It provides information on lifestyle and environmental factors that can increase cancer risk, such as smoking, obesity, alcohol consumption, certain chemicals and radiation. Maintaining a healthy diet, being physically active, avoiding tobacco and excessive sun exposure can help prevent some cancers. Screening guidelines and key websites for cancer information are also listed. The document emphasizes that prevention through modifying risk factors is the best approach to reducing the cancer burden.
This document provides information about cancer and diabetes. It defines cancer as a group of diseases characterized by uncontrolled cell growth, and notes the four main types: carcinomas, sarcomas, leukemias, and lymphomas. Environmental factors that can lead to cancer include tobacco, obesity, pollution, and lack of exercise. The document also outlines diabetes, defining the two main types, symptoms, and the National Diabetes Control Programme in India. It concludes that cancer and diabetes are chronic diseases prevalent in obese populations, and can be prevented by controlling diet, exercise, smoking and drinking.
Cancer is characterized by uncontrolled growth and spread of abnormal cells. There are over 200 types of cancer. Cancer cells lose control over growth and multiplication and do not self-destruct like normal cells. Some key causes of cancer include tobacco, alcohol, diet, viruses, genetics, and environmental factors like pollution. Symptoms can include lumps, unexplained weight loss, changes in bowel or bladder function, and more. Common cancer types include lung, breast, colon, prostate, and leukemia. Diagnosis involves screening tests, biopsies, and scans. Treatments include surgery, radiation, chemotherapy, immunotherapy and more. Preventive measures include exercise, healthy diet, avoiding tobacco and excessive alcohol.
Dr Pradeep Jain Reviews, Fortis Hospital - Why, Who, When and What of Weight ...Dr Pradeep Jain Reviews
Dr Pradeep Jain Reviews, Fortis Hospital - Why, Who, When and What of Weight Loss. Dr Pradeep Jain Fortis has wide experience of Gastroenterology Surgery.
This document discusses disparities in heart disease among women of different ethnicities. It summarizes that Native American, Hispanic, and African American women have higher rates of heart disease mortality compared to Asian American and white women. It then discusses various risk factors for heart disease like high cholesterol, diabetes, obesity rates, exercise levels, and smoking rates among different ethnic groups of women. It also addresses biases in referral to certain cardiac procedures and treatments among African American patients.
This document discusses nutrition considerations for recreational athletes. It covers several topics:
- Nutrition can help reduce and prevent pain or injury, facilitate healing, enhance performance, and maximize health for recreational athletes. Specific factors discussed include caloric intake, hydration, macronutrient consumption, supplementation, and inflammation/perfusion as they relate to joint health and performance.
- Body weight, obesity, and resulting inflammation are significant risk factors for pain and injury. Maintaining a healthy weight through calorie reduction and increased consumption of plant-based foods can help reduce biomechanical load on joints and lower inflammatory markers.
- Proper nutrition and reduced consumption of high-fat, high-cholesterol meals can enhance perfusion and blood
Ueda2016 diabetes & cancer - mesbah kamelueda2015
Diabetes and certain cancers are linked by shared risk factors like obesity and age. People with diabetes have higher risks of cancers of the liver, pancreas, endometrium, and colon and breast cancers. The biological mechanisms linking the diseases involve insulin and insulin-like growth factors stimulating cancer cell growth. While hyperglycemia is not an independent risk factor, it can worsen cancer outcomes. Metformin may reduce cancer risk compared to other diabetes medications by activating AMPK, an energy sensor that puts cells in energy-saving mode and inhibits cancer cell growth. Further research is still needed to fully understand the diabetes-cancer relationship and its implications for treatment and management.
Alzheimer's is a gradual mental decline that destroys cognitive abilities over time. It progresses from mild forgetfulness to severe memory loss and inability to perform basic tasks. While the exact cause is unknown, risk factors include age, family history, head injuries, and medical conditions. Symptoms start with memory loss and confusion and worsen to include changes in personality and behavior. Home remedies like consuming carrots, fish, and vitamins E and B may help curb Alzheimer's progression, though it currently has no cure.
Alzheimer's disease is a fatal brain disorder that causes memory loss and cognitive decline. It destroys brain cells and affects thinking, behavior, and ability to perform daily tasks. Risk increases with age and there is no known cure. The document lists numerous causes and symptoms of Alzheimer's as well as potential treatment strategies like consuming foods rich in vitamins, fish, herbs, and seeds.
This document discusses metabolic syndrome, including its definition, causes, risk factors, prevalence in different populations, and treatment approaches. Metabolic syndrome is a cluster of conditions that increases the risk of cardiovascular disease and diabetes. It is characterized by abdominal obesity, high blood pressure, insulin resistance, and dyslipidemia. Lifestyle interventions like diet modification, increased physical activity, and weight loss are effective first-line treatments to reduce the risk factors of metabolic syndrome. The document reviews evidence on how different diets, exercises and weight management can help control metabolic syndrome.
The document discusses the history and development of exercise science as a discipline. It highlights some of the early leaders in Scandinavia and discusses seminal research findings showing the health benefits of cardiorespiratory fitness (CRF) and muscular strength. Several studies from the Aerobics Center Longitudinal Study are summarized that demonstrate the inverse associations between CRF and mortality from cardiovascular disease and other causes. Additional research is reviewed showing the benefits of exercise for chronic disease populations and older adults. The role of exercise as an evidence-based treatment for diseases like diabetes is emphasized.
1) A 46-year-old man with type 2 diabetes, hypertension, obesity, and dyslipidemia presented with erectile dysfunction. Laboratory tests confirmed metabolic syndrome and hypogonadism.
2) The patient meets criteria for metabolic syndrome according to NCEP-ATP III guidelines due to diabetes, hypertension, abdominal obesity, and low HDL. Hypogonadism was diagnosed based on low total testosterone, free testosterone, and bioavailable testosterone levels.
3) Guidelines recommend screening patients with diabetes and symptoms of hypogonadism for low testosterone. The patient should have been screened for erectile dysfunction due to his risk factors of diabetes and metabolic syndrome.
Cancer 101 provides an overview of cancer including definitions, statistics, risk factors, and lifestyle measures for prevention. It reviews that cancer is abnormal cell growth, the second leading cause of death, and risk is increased by certain lifestyle behaviors like poor nutrition, lack of exercise, stress, sleep issues, and toxic exposures. Maintaining a healthy lifestyle through diet, exercise, managing stress, adequate sleep, and avoiding toxins can help lower cancer risks.
This document discusses the link between diabetes and cancer. It notes that cancer and diabetes are diagnosed together more frequently than expected by chance. Several risk factors are shared between the two diseases, including age, diet, obesity, and lifestyle factors. The document explores how insulin and IGF-1 may influence cancer development via their effects on cell growth pathways. It reviews evidence on the effects of different diabetes medications, including some studies that found certain insulin analogs may increase cancer risk. Several cohort studies on the cancer risks of insulin glargine are also summarized.
Harnessing the Power of Nutrition to Complement Brain Tumor CareJeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at the 1st Annual Brains Matter conference (Sept 2012 in Seattle), sponsored by the Chris Elliott Foundation. Learn how nutrition can play a powerful role to influence the terrain (environment) surrounding cancer cells. Discover foods that can "talk" to your genes, suppressing oncogenes and turning on tumor suppressor genes. Explore simple diet and lifestyle changes you can make to nourish your wellness when facing a brain tumor diagnosis.
Understanding how intermittent fasting may not only help weight loss but have multiple other health benefits including life prolongation, preventing cancer and dementia
Considering the mechanisms behind cancer cachexia-anorexia can inform wiser n...Jeanne M Wallace PhD
Unwanted weight loss and lack of interest in food drives many cancer patients to conventional canned nutrition formulas like Ensure, but these may actually foster the oncogenic process. This article outlines the underlying physiology of cachexia and compares various feeding formulas including holistic nutrition options.
This document outlines recommendations from the World Cancer Research Fund for reducing cancer risk through lifestyle choices. It discusses 10 main recommendations, including maintaining a healthy weight, being physically active, eating a plant-based diet with limited red meat and processed meats, limiting alcohol intake, and not smoking or chewing tobacco. The recommendations are based on extensive reviews of scientific evidence on diet, nutrition, and cancer prevention. The role of health professionals is discussed, including educating patients on following a healthy lifestyle to reduce their cancer risk and supporting cancer survivors.
Food choices can help prevent cancer and, when cancer has been diagnosed, nutrition can improve survival. These links between diet and cancer are nothing short of dramatic. And now you can learn how certain dietary patterns help people diagnosed with cancer live longer, healthier lives.
Ueda2016 metabolic syndrome in different population,which one is appropriate ...ueda2015
Metabolic syndrome is a cluster of disorders including high blood pressure, high insulin levels, excess body weight, and abnormal cholesterol that increases the risk of diseases like diabetes and heart disease. There is wide variation in the reported prevalence of metabolic syndrome across populations and definitions, and questions remain about its applicability and predictive power equally in all groups. Key determinants include obesity, especially abdominal obesity, and insulin resistance, but genetic and lifestyle factors also contribute to risk.
This document discusses cancer prevention and screening. It provides information on lifestyle and environmental factors that can increase cancer risk, such as smoking, obesity, alcohol consumption, certain chemicals and radiation. Maintaining a healthy diet, being physically active, avoiding tobacco and excessive sun exposure can help prevent some cancers. Screening guidelines and key websites for cancer information are also listed. The document emphasizes that prevention through modifying risk factors is the best approach to reducing the cancer burden.
This document provides information about cancer and diabetes. It defines cancer as a group of diseases characterized by uncontrolled cell growth, and notes the four main types: carcinomas, sarcomas, leukemias, and lymphomas. Environmental factors that can lead to cancer include tobacco, obesity, pollution, and lack of exercise. The document also outlines diabetes, defining the two main types, symptoms, and the National Diabetes Control Programme in India. It concludes that cancer and diabetes are chronic diseases prevalent in obese populations, and can be prevented by controlling diet, exercise, smoking and drinking.
Cancer is characterized by uncontrolled growth and spread of abnormal cells. There are over 200 types of cancer. Cancer cells lose control over growth and multiplication and do not self-destruct like normal cells. Some key causes of cancer include tobacco, alcohol, diet, viruses, genetics, and environmental factors like pollution. Symptoms can include lumps, unexplained weight loss, changes in bowel or bladder function, and more. Common cancer types include lung, breast, colon, prostate, and leukemia. Diagnosis involves screening tests, biopsies, and scans. Treatments include surgery, radiation, chemotherapy, immunotherapy and more. Preventive measures include exercise, healthy diet, avoiding tobacco and excessive alcohol.
Dr Pradeep Jain Reviews, Fortis Hospital - Why, Who, When and What of Weight ...Dr Pradeep Jain Reviews
Dr Pradeep Jain Reviews, Fortis Hospital - Why, Who, When and What of Weight Loss. Dr Pradeep Jain Fortis has wide experience of Gastroenterology Surgery.
This document discusses disparities in heart disease among women of different ethnicities. It summarizes that Native American, Hispanic, and African American women have higher rates of heart disease mortality compared to Asian American and white women. It then discusses various risk factors for heart disease like high cholesterol, diabetes, obesity rates, exercise levels, and smoking rates among different ethnic groups of women. It also addresses biases in referral to certain cardiac procedures and treatments among African American patients.
This document discusses nutrition considerations for recreational athletes. It covers several topics:
- Nutrition can help reduce and prevent pain or injury, facilitate healing, enhance performance, and maximize health for recreational athletes. Specific factors discussed include caloric intake, hydration, macronutrient consumption, supplementation, and inflammation/perfusion as they relate to joint health and performance.
- Body weight, obesity, and resulting inflammation are significant risk factors for pain and injury. Maintaining a healthy weight through calorie reduction and increased consumption of plant-based foods can help reduce biomechanical load on joints and lower inflammatory markers.
- Proper nutrition and reduced consumption of high-fat, high-cholesterol meals can enhance perfusion and blood
Ueda2016 diabetes & cancer - mesbah kamelueda2015
Diabetes and certain cancers are linked by shared risk factors like obesity and age. People with diabetes have higher risks of cancers of the liver, pancreas, endometrium, and colon and breast cancers. The biological mechanisms linking the diseases involve insulin and insulin-like growth factors stimulating cancer cell growth. While hyperglycemia is not an independent risk factor, it can worsen cancer outcomes. Metformin may reduce cancer risk compared to other diabetes medications by activating AMPK, an energy sensor that puts cells in energy-saving mode and inhibits cancer cell growth. Further research is still needed to fully understand the diabetes-cancer relationship and its implications for treatment and management.
Alzheimer's is a gradual mental decline that destroys cognitive abilities over time. It progresses from mild forgetfulness to severe memory loss and inability to perform basic tasks. While the exact cause is unknown, risk factors include age, family history, head injuries, and medical conditions. Symptoms start with memory loss and confusion and worsen to include changes in personality and behavior. Home remedies like consuming carrots, fish, and vitamins E and B may help curb Alzheimer's progression, though it currently has no cure.
Alzheimer's disease is a fatal brain disorder that causes memory loss and cognitive decline. It destroys brain cells and affects thinking, behavior, and ability to perform daily tasks. Risk increases with age and there is no known cure. The document lists numerous causes and symptoms of Alzheimer's as well as potential treatment strategies like consuming foods rich in vitamins, fish, herbs, and seeds.
This individual has experience serving children with vision/hearing impairments and multiple disabilities. They provide translation services in Spanish for families and organizations. They act as a liaison between families and state/medical agencies regarding eligibility and developing individualized plans. They use instructive tools to facilitate development based on outcomes in individualized plans.
The document provides an overview of the LIFT project, which aims to improve linkages between HIV/AIDS clinical services and economic strengthening programs. It discusses research conducted in Ethiopia and Namibia to identify challenges and promising practices around referral systems. Key findings include the importance of designated case managers, community coordination committees, and formalizing bi-directional referral processes between clinics and community organizations. The LIFT model proposes strengthening existing economic strengthening services, identifying gaps, and engaging the private sector to improve sustainable employment for clients of HIV clinical programs.
1. Mozambique has high rates of undernutrition and HIV prevalence, especially in the southern provinces. Over 350,000 children under 5 are undernourished.
2. The document discusses potential linkages between health facilities and community programs to better integrate nutrition, agriculture, WASH, and HIV interventions. This includes referrals between community groups and health centers.
3. Recommendations include expanding HIV clinical partners' nutrition programs, strengthening community-facility referrals under Feed the Future and PEPFAR, and increased coordination between donors and partners on integrated programming.
This document discusses effective monitoring and evaluation (M&E) integration at the clinic level. It outlines three key lessons: 1) use metrics relevant to the specific clinic, such as denominators that reflect the clinic's patients; 2) make data collection part of daily clinic routines and document it in existing clinic tools; and 3) use monthly data reviews and analysis to identify service gaps and test ways to improve performance and close those gaps. The document provides examples of implementing these lessons from clinics in Kenya that successfully increased nutritional assessments of HIV-infected patients.
This document describes Partners in Health's integrated community-based model for improving HIV and nutrition outcomes in rural Malawi. The key components are:
1) Village health workers who monitor community health and refer malnutrition cases.
2) Community engagement through nutrition education, support groups, and outreach.
3) Direct nutritional support at health centers for malnourished and HIV/TB patients using corn soy blend and therapeutic food.
The model has expanded from serving 5 ART patients in 2006 to over 4,000 across 12 sites in 2011. Challenges include logistics, funding, and human resources which the program addresses through partnerships.
1) Obesity rates have doubled worldwide in the past few decades and over 1 billion people are now overweight or obese globally.
2) Developing countries are beginning to experience nutrition transitions where physical activity levels decrease and diets become more calorie-dense, leading to growing obesity problems.
3) Bariatric surgery is an effective treatment for severe obesity, resulting in over 60% excess weight loss on average and resolution of related health conditions like diabetes and hypertension for the majority of patients.
This document discusses the relationship between obesity and cancer. It notes that cancer causes more deaths worldwide than malaria, tuberculosis, HIV, or childhood diarrhea combined. Obesity is a leading cause of several types of cancer. Randomized controlled trials have shown that intentional weight loss reduces levels of inflammatory markers like CRP that are implicated in cancer development. Understanding the biological mechanisms such as hormones, growth factors, and inflammation linking obesity to cancer can help identify targets for prevention through lifestyle changes and weight management.
Understant what is obesity and Bariatric Surgery, what are the risk factors and how to overcome on the it. For more information visit at http://gisurgery.info
Obesity is a chronic, debilitating, life long disease giving rise to many other diseases. Severe obesity is
associated with co-morbidities including type 2 DM, hypertension, dyslipidemia, obstructive sleep apnoea,
obesity hypoventilation syndrome, polycystic ovarian syndrome, stateohepatosis, asthma, back and lower
limb degenerative problem, cancer and premature death. Morbid obesity has acquired epidemic proportions in the west. Traditional approaches to weight loss including diet, exercise and medication achieve no more than 5-10 % reduction in body weight with high relapse rates. So far, there was no effective remedy for morbid obesity. Bariatric surgery is the only effective means of achieving long term weight loss in the severely obese. The international guideline for bariatric surgery are BMI > 40 kg/m2 BMI > 35 kg/m2 together with obesity related disease. Bariatric surgery can achieve sustained weight loss durable to at least 15 years and causes marked improvement in co-morbidities.
My seminar Obesity by Hani
Obesity is a public health and policy problem because of its increase prevalence, costs and health effect. (WHO, 2012, National heart lung and blood institute. 2012)
. The risk factor for chronic disease are highly prevalence (Zindah, Belbeisi, Walke & Makdad 2008)
The obesity and the overweight are risk for number of chronic disease include diabetes cardio vascular disease and cancer (WHO,2010)
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This document discusses recent advances in surgical treatment for obesity, focusing on laparoscopic gastric band surgery. It provides definitions of obesity, discusses the prevalence and health risks of obesity in Australia. It then summarizes the LAP-BAND system, how it works to promote weight loss through reduced hunger, outcomes data showing its effectiveness at sustained weight loss comparable to other surgeries, and costs/insurance coverage. Contact information is provided for those interested in a consultation to see if they are a candidate for the LAP-BAND procedure.
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Background: India has a serious Abdominal Obesity (AO) concern with a frequency of 24.8%, particularly among metropolitan especially in women. Generalised obesity (GO) & AO, both of which are associated with greater rates of mortality & morbidity. In India, AO is more prevalent than GO (24.5%), & it has been associated to a number of health hazards, including the metabolic syndrome, insulin resistance, & cardiovascular diseases (CVD), high blood pressure & PCOS.
Prevalence of obesity.Body composition & body shape (body fat distribution ) and CVD risk .Mechanisms linking obesity with cardiovascular disease.Fat-but-Fit Paradigm and CVD,The Relationship of Metabolic Risk Factors and Cardiorespiratory Fitness. Metabolically Healthy but Obese ( MHO ) Phenotype and CVD.Obesity Paradox in Patients With CVD
The document discusses obesity, including its prevalence, complications, and treatment. Some key points:
- Obesity is defined as having a BMI of over 30 or excess body fat of over 20%. It results from consuming more calories than expended.
- It is common worldwide and in countries like India and China. In the US, over 30% of adults are obese, costing $147 billion annually.
- Obesity increases the risk of conditions like diabetes, high blood pressure, high cholesterol, heart disease, stroke, arthritis, and some cancers.
- Treatment involves lifestyle changes like diet and exercise. For higher-risk patients, treatment may include medication or surgery to help with weight loss and reduce
Ethnic differences, obesity and cancer,
stages of the obesity epidemic and cancer prevention
Professor TH Lam, JP, BBS
MD, FFPH, FFOM, Hon FHKCCM, FHKAM, FRCP
Sir Robert Kotewall Professor in Public Health, School of Public Health, The University of Hong Kong
UICC World Cancer Congress Melbourne, Australia 3-6 December 2014
This document provides information on the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in India. It details the high burden of non-communicable diseases in India, led by cardiovascular disease, diabetes, chronic respiratory disease, and cancer. The objectives and strategies of the NPCDCS aim to prevent, screen, diagnose, and manage these conditions through a public health approach. The document also provides details on screening and management of the three major cancers in India - breast, cervical, and oral cancers - under the NPCDCS.
Developing a cancer survivorship research agenda - Prof Patricia GanzIrish Cancer Society
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This document discusses obesity and its relationship to heart disease. It defines obesity and describes how both genetic and behavioral factors contribute to being overweight. Visceral abdominal fat is associated with insulin resistance and metabolic syndrome, increasing risks for type 2 diabetes, hypertension, and cardiovascular disease. Obesity causes heart disease through mechanisms like insulin resistance, inflammation, and increased stress on the heart from carrying excess weight. Modest weight loss through diet and exercise can significantly reduce cardiovascular risks. Anti-obesity medications and bariatric surgery are treatment options for severe obesity when more conservative measures have failed.
The document discusses the epidemiology of obesity globally and in India. It notes that obesity prevalence has risen dramatically worldwide and in India over past decades. Obesity is associated with increased risk of many non-communicable diseases like diabetes, cardiovascular disease and certain cancers. The document outlines factors contributing to obesity like diet, physical activity levels, genetics and environment. It provides data on obesity trends in India from various studies as well as prevalence of overweight and obesity in children and adults.
The document outlines the elements of a Nutrition Assessment, Counseling and Support (NACS) approach which includes:
1) Providing nutrition support through clinics that offer therapeutic, supplementary and complementary foods by prescription along with nutrition care plans, assessment and counseling.
2) Engaging communities through household food security, economic strengthening programs, and working with community health workers.
3) Addressing gaps in limited linkages and referrals between clinics and communities by implementing a coordinated NACS approach along the continuum of care in a client-centered way with assessment, counseling, support, referrals and coordination.
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This document provides a historical perspective on the CORE Group Members and the Links for Life/FANSHA process. It discusses [1] CORE Group's emphasis on integrating nutrition, HIV/AIDS, and other working groups, [2] the Links for Life initiative including Africa Forums in 2006 and 2009 and FANSHA which brought together over 200 front-line workers, and [3] the formation of FANSHA in 2006 as an advocacy group to strengthen awareness of the interaction between food/nutrition insecurity and HIV/AIDS.
The document discusses integrating nutrition assessment, counseling and support (NACS) with community management of acute malnutrition (CMAM) and maternal, newborn and child health (MNCH) programs in Ethiopia and Mozambique. In Ethiopia, NACS was scaled up in health facilities and partially integrated with MNCH and HIV services. Key challenges included different guidelines, high defaulter rates, and separate supply chains. In Mozambique, NACS was integrated into existing CMAM covering children and adults. Benefits included one protocol and reduced stigma, while challenges included diluted HIV focus and complex reporting. Both countries are exploring effective referral systems and using CMAM to improve infant and young child feeding for HIV-
This document summarizes the results of a food by prescription pilot program integrated into HIV care in Zambia between 2008-2010. The pilot provided nutrition assessment, counseling, and food rations to over 5,000 clients across various clinic and community settings. Key challenges included integrating nutrition services into busy clinics with limited staff time and space, and establishing supply chains for specialized foods outside existing systems. Recommendations focused on systematizing nutrition assessment and counseling through policies, training, and tools to make these routine practices across various service delivery points for sustainable integration of nutrition support into HIV care.
This document discusses the creation of relevant monitoring and evaluation (M&E) frameworks for Nutrition Assessment, Counseling, and Support (NACS) programs. It outlines the need for harmonized global indicators to measure NACS interventions internationally. Steps are provided for developing a NACS M&E framework, including assessing program effectiveness, identifying best practices, and reporting results. Thematic areas and examples of NACS indicators are given. The document concludes by addressing gaps in NACS M&E and next steps, such as measuring quality of services and strengthening community linkages.
The document describes a quality improvement project in Kenya that aims to improve nutrition services for people living with HIV in Nyanza Province. It identifies common challenges like high dropout rates and issues with food storage and sharing. The project will implement a quality improvement approach at 11 health facilities in 4 districts, using techniques like identifying problems, testing changes, and measuring improvements. The goal is to enhance nutritional assessment, counseling, and care for clients at each visit.
1) The document describes Uganda's experience with a quality assurance and quality improvement approach along the health facility-community continuum for treating malnutrition.
2) It discusses using a coaching/mentoring model at health sites to improve quality and introducing a case management approach.
3) The NuLife project in Uganda from 2008-2011 took an integrated approach involving strengthening policies, improving service delivery through quality clinics and community linkages, and establishing local RUTF production and supply chains to treat malnutrition.
1) The document discusses approaches to integrating nutrition assessment, education, and counseling (NACS) services into HIV care in Kenya through a continuum of care model.
2) It outlines defining different service packages based on nutritional status assessed through anthropometric measurements. This includes counseling, supplementation, and referrals for normal, moderately, and severely malnourished patients.
3) Achieving scale of NACS will require securing political commitment, leadership, planning, implementation resources and identifying delivery channels through public, private, faith-based, and other partners across various levels of Kenya's health system. Charts show growing enrollment in NACS and expansion of supplementation sites over time.
Liebig's Law of the Minimum states that plant growth and crop yields are controlled not by the total amount of resources available, but by the scarcest resource (limiting factor). The three key points are:
1) Yield is proportional to the amount of the most limiting nutrient, whichever nutrient it may be.
2) Nutrients must be available in adequate proportions relative to the needs of the plant or crop.
3) Increasing the amount of non-limiting resources does not increase the yield, whereas increasing the limiting resource can increase yield.
This document summarizes several studies on the impacts of supplementary feeding for adults living with HIV. A randomized controlled trial in Kenya found that supplementary food led to greater improvements in nutritional status and higher clinic attendance among pre-ART clients. A study in Malawi found patients receiving a fortified spread had greater BMI increases than those receiving corn-soy blend, with no differences in mortality, CD4, or viral load. A study in Zambia found food supplementation was associated with better antiretroviral therapy adherence. A study in India found supplementation resulted in weight and BMI gains only for patients with low CD4 counts.
The document discusses evidence related to the design of Nutrition and Care Support (NACS) programs. It raises questions about what the existing evidence tells us about how to structure NACS interventions and priorities. The document also debates whether the focus of NACS programs should be on HIV or nutrition outcomes and identifies priorities for further research and types of information that need standardization.
This document discusses the relationship between HIV/AIDS and malnutrition and provides guidance on integrating nutrition into HIV care. It summarizes reports from WHO on nutrient requirements for people living with HIV/AIDS and the need to integrate nutrition into treatment. The document also describes the Kenya Food Prescription Program and NACS (Nutrition Assessment, Counseling & Support) approach to addressing food and nutrition needs through clinical management, community support, and multiple entry points.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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1. Getting the Knack of NACS:
Nutrition Implications of HIV and ART
Alice Tang, Ph.D.
Tufts School of Medicine
Washington, DC
February 22-23, 2012
2. Learning Objectives
Review of scientific evidence:
1. To understand interactions between nutrition
and HIV
2. To understand the nutrition implications of ART
3. Outline
Nutrition research prior to ART
Nutrition research post-ART rollout
How do nutritional status and food insecurity affect:
• PLWHA at uptake/initiation of ART,
• PLWHA on ART (adherence), and
• Patient outcomes on ART (measured by indices
such as CD4 count, viral load, and mortality)
4. HIV – Nutrition Spiral
Insufficient dietary intake
Malabsorption and diarrhea
Impaired storage and altered metabolism
Malnutrition:
HIV Infection Protein-energy malnutrition
Micronutrient deficiencies
Nutritionally acquired immunodeficiency
5. Etiology of Malnutrition
in HIV infection
Decreased Dietary Intake:
• Food
insecurity, depression, anxiety, anorexia, physical
symptoms that impair intake (oral
lesions, bloating, diarrhea, constipation)
Malabsorption of micro- and macro- nutrients
• Antibiotic effects on intestinal flora, HIV-induced
mucosal changes, ARV effects, gastrointestinal
infections
Altered Metabolism:
• Fever or inflammatory effects on basal metabolic
rate, hormonal deficiencies, ARV effects
6. Pre-ART: Focus on weight loss and
micronutrient deficiencies
Weight loss and low micronutrient levels
associated with increased progression of disease
Death associated with weight less than 66% of
ideal body weight
Death associated with lean body mass falling below
54%
As little as 3-5% weight loss associated with
mortality
Kotler, 1989; Chlebowski, 1989; Guenter, 1993; Palenicek,
1995; Wheeler,1996; Jones, 2003; Tang, 2005
7. 2003 World Health Organization
Dietary Recommendations for HIV
Energy Requirements to maintain weight
• Increase by ~10% in asymptomatic HIV
• Increase by 20-30% in symptomatic HIV/AIDS
Protein Requirements
• No evidence exists for increased needs
• ~10% increase with OI
Micronutrient Requirements
• No evidence to support taking supplements
above DRI
9. What we know…
Low BMI at ART initiation is associated with
increased mortality
ART initiation is associated with weight gain
Early weight gain on ART is associated with
survival, particularly when baseline BMI is low.
10. Baseline nutritional status predicts
ART survival
Author, Year Country N Mortality Predictors of Mortality
Severe, 2005 Haiti 1004 10% (6M) AIDS-defining illness, CD4≤50 cells/µl, low weight
13% (12M) (lowest quartile for sex)
Ferradini, 2006 Chiradzulu 1266 19% (8M) BMI<18.5, WHO stage IV, male sex, and baseline
district, Malawi CD4<50
Paton, 2006 Singapore 394 20% (29M) BMI<17, WHO Stage, non-HAART
Zachariah, 2006 Thyolo district, 1507 8% (3M) WHO stage IV, CD4≤50 cells/µl, and BMI<16 kg/m2
Malawi 13% (24M)
Stringer, 2006 Lusaka, Zambia 16,198 5% (3M) CD4 count, WHO stage, BMI<16 kg/m2, severe
anemia, and poor adherence to ART.
Calmy, 2006 11 countries 6861 7% (6M) Male gender, WHO stages III & IV, BMI<18 kg/m2,
(Africa, Asia, 10% (12M) CD4<15 cells/µl, Hgb<100 g/l.
Central America)
Erikstrup, 2007 Zimbabwe 196 HIV RNA level, HB, CD4 cell count, and CDC category
Barth, 2008 Elandsdoorn, 675 19% (12M) Karnofsky score ≤50, CD4<50
South Africa
Johannessen, 2008 Tanzania 320 18% (3M) Moderate/severe anemia, thrombocytopenia, and
30% (11M) BMI<16 kg/m2
Marazzi, 2008 Mozambique, 3456 53% (6M) BMI <18.0 kg/m2, Hgb, clinical staging, viral load,
Tanzania, Malawi and CD4 cell counts
Toure, 2008 Cote d’Ivoire, 10 211 15% (18M) Male gender, Age, CD4<150, WHO stages 3 and 4,
West Africa Hgb, BMI<18.5, type of care center
Srasuebkul, 2009 17 clinics in Asia- 1663 29% (20M) BMI≤18, mild to severe anemia, CD4≤200, age≤29
Pacific region
12. What we know…
Low BMI at ART initiation is associated with
increased mortality
ART initiation is associated with weight gain
Early weight gain on ART is associated with
survival, particularly when baseline BMI is low.
[Madec, 2009; Olawumi, 2008; Ross-Degnan, 2010;
Saghayam, 2007; Tang, 2011]
13. ART initiation is associated
with weight gain
BMI<=17
BMI: >17 to <=18.5
BMI: >18.5 to <=20
BMI: >20
Madec et al, AIDS 2009
14. ART initiation is associated
with weight gain
BMI<=17
BMI: >17 to <=18.5
BMI: >18.5 to <=20
BMI: >20
Madec et al, AIDS 2009
15. What we know…
Low BMI at ART initiation is associated with
increased mortality
ART initiation is associated with weight gain
Early weight gain on ART is associated with
survival, particularly when baseline BMI is low.
16. Baseline BMI and 6 month weight gain as a predictor of mortality
BMI<16.0 BMI 16.00-16.99
BMI>18.5
BMI 17.00-18.49
Koethe et al. JAIDS 2010
17. BMI and weight gain at M3* increases
mortality during 3-6 month period
* M3 = 3 months on ART
Madec et al, AIDS 2009
18. BMI and weight gain at M6* increases
mortality during 6-12 month period
*M6 = 6 months on ART
Madec et al, AIDS 2009
19. BMI and CD4 response
No association between BMI and magnitude of
CD4 recovery
CD4 response appears to modify the
association between BMI and mortality
• Low BMI and attenuated CD4 response (≤99
cells/mm3 increase or CD4 decline) is a
strong predictor of mortality.
20. BMI and CD4 response
Author, Year Country N BMI predicts CD4 response?
Paton, 2006 Singapore 394 No
Barth, 2008 Elandsdoorn, 675 Yes (BMI<17.1)
South Africa
Toure, 2008 Cote d’Ivoire, 10 211 No
West Africa
Koethe, AIDS, Lusaka, 56,612 Yes, but not clinically
2010 Zambia significant
Kiefer, 2011 Rwanda 537 F No
Tang Vietnam 100 M No
(Unpublished)
22. BMI and CD4 response
No association between BMI and magnitude of
CD4 recovery
CD4 response appears to modify the
association between BMI and mortality
• Low BMI and attenuated CD4 response (≤99
cells/mm3 increase or CD4 decline) is a
strong predictor of mortality.
23. Adjusted hazard ratios of death, by
baseline BMI and CD4 change
6 months on ART Koethe et al, AIDS 2010
24. Knowledge Gaps
What we know so far…
• Baseline nutritional status (BMI) predicts ART survival
• Weight changes appear to parallel the success of ART
• Weight and CD4 gains on ART associated with lower
risk of death
What we don’t know…
Will interventions to improve weight (BMI) prior to or at
ART initiation improve subsequent outcomes?
Are baseline BMI and weight gain just a marker for
disease severity?
Issues of timing – nutritional support and ART
26. What is Food Insecurity?
Household level: Lack of access for all members at
all times to enough food to lead active, healthy
lives.
Individual level: Inability to meet food needs at all
times in socially acceptable ways.
Food insecurity leads to worse health outcomes
across a range of diseases (heart disease,
diabetes, obesity, and depression) [Seligman 2007;
Seligman 2010]
27. HIV and Food Insecurity:
What do we know?
High prevalence of food insecurity in HIV infected
populations (nearly half of HIV+ urban poor) (Normen
2005; Kalichman 2010; Anema 2011; McMahon 2011)
Globally, inadequate access to food and safe water can
be a barrier to ART uptake and adherence (Weiser 2010;
Chakrapani 2008; Franke 2010; Kalichman 2011; Nagata 2011)
Food insecurity associated with incomplete viral
suppression, reduced CD4 response, and increased
mortality (Weiser 2008; Wang 2011; Kalichman 2010; McMahon
2011; Weiser 2009)
See review articles by Weiser et al. 2011, Anema et al.
2009, and Ivers et al. 2009.
28. Food insecurity is a barrier to ART
uptake and adherence
Reviewed by Bartlett, 2009 and Vervoort, 2007
Food insecurity barriers:
• 76% feared developing too much appetite on ART but
not having enough to eat [Au, 2006].
• ART costs (e.g. transportation, registration and user
fees, and lost wages due to long waiting times)
undermine family welfare [Crane, 2006; Hardon, 2007].
• Long-term lifestyle changes: avoiding all alcohol and
smoking, eating sufficient quantities of food regularly,
and always having sex with condoms [Murray, 2009].
• Increased hunger, worse ARV side-effects w/o food,
counseling on need for food with ART, competing
demands between food and health care expenses,
forgetting to take ARV’s when working or searching for
food [Weiser, 2010].
29. Barriers to free ART for injecting
drug users (IDU) in India
Lack of access to adequate/nutritious food
prevents IDUs from start taking ART
• They [IDUs] become afraid as they [counselor/doctor]
say that there would be side-effects.
• We are asked to take good food but we don‟t even have
food at times.
• We are afraid that something might happen if we take
[ART] without taking food.‟
Chakrapani, V., Velayudham, J., Michael, S., Shanmugam, M. (2008).
Barriers to free antiretroviral treatment access for injecting drug users in
Chennai, India. Indian Network for People living with HIV and AIDS
(INP+), Chennai, India.
30. Barriers to free ART for injecting
drug users (IDU) in India
For homeless IDU getting food (and drugs) would
be a priority – not taking ART
• „He is on the roads [homeless IDU]. What will he do if
he is given ART? He doesn‟t have food to eat.
• For him [getting] food is more important than ART.
Chakrapani, 2008
31. Barriers to free ART for injecting
drug users (IDU) in India
Food menu offered by counselors is “Only for
rich”
• Can the one on platform [homeless] drink hot
water? Can he take nutritious food such as nuts,
dates, dal? He would just nod his head to the
counselor while all these questions keep flashing in
his mind. He doesn‟t get admitted - neither does he
get ART. He thinks, “Oh! There is so much in this
[taking ART]. So let me continue doing whatever I
am doing now and die when I am going to”.‟
Chakrapani, 2008
32. HIV
• Loss of income • Stigma
• Loss of labor (farming) • Isolation
• Cost of ART ($ and time) • Depression
Food Insecurity
Physical: Psychosocial: Depression, Worry,
Under- (or over) nutrition Anxiety, Fear of Hunger, Stigma
Reduced Health and Function:
Malnutrition – exacerbates HIV
Adverse family and social interactions
Substance Abuse
Increased HIV risk behaviors
Inability to initiate/tolerate/adhere to ART
Ivers, 2009; Frega, 2010;Weiser, 2011;
33. HIV and nutrition nexus – which
approach should NACS programs take?
Address direct biological effect of nutrition status
on HIV disease progression
• Increase energy intake
• Increase protein intake
• Micronutrient repletion
Address social determinants of food insecurity
and barriers to adherence.
34. HIV and nutrition nexus – which
approach should NACS programs take?
Low BMI
Early mortality
on ART
Food
Insecurity Poor CD4 response,
incomplete viral
suppression
35. Conceptual model
Short-term food support
for substance users
in South India
Temporary food security
Ability to participate in mental health/other programs
Improvement in mental health
Improved health and function:
- Improved family and social interactions
- Decreased HIV risk behaviors
- Decreased alcohol use
- Improved nutritional status
- For HIV+’s: ability to start ART and
improved response to ART
Long-term food security
Editor's Notes
I would like to thank the organizers for inviting me to speak at this meeting. As an academic researcher I am really looking forward to these next couple of days hearing about different nutrition programs in the field and to discuss what has and hasn’t worked and next steps.
People are starting ART too late – late diagnosis or other issues (stigma, depression, denial)? What are the barriers to starting ART?When to start nutritional support? Prior to ART eligibility? How soon prior and how would these programs work? What factors play a role in poor CD4 response? Nutrition related or not? What role does adherence play? If so, what are the barriers to adherence? It turns out that poor nutritional status not only has a direct biological role in immune response, but also may play a role through ART adherence.
HIV puts people/households at risk of food insecurityCost of ART leads to reallocation of funds away from foodDrugs increase appetite – necessary fuel for immune function and body to recuperate from infectionsI put FI in the middle, A mental health person might put mental health in the middle, a nutrition person might put malnutrition in the middle, an ID person might put HIV in the middle. The point is that this diagram should look like a tightly knotted ball of string – most of these arrows can go in both directions, most of the boxes are related to all the other boxes. Pick one link and you will find a multitude of studies that show evidence of an association. But there is no evidence that one of these links is stronger than the other links. Interventions are like pulling at one piece of string to try to unravel the knot. Pull at one string to see what happens, where it leads.
Interestingly, the link between BMI and Food Insecurity is not strongly established in the literature. This could depend on how food insecurity is defined. FI incorporates several domains including worry/anxiety about getting enough food, lack of dietary diversity, and insufficient intake. It’s possible that some domains are stronger drivers of food insecurity and therefore FI is not associated with low BMI in certain populations who are food insecure and spend their time finding food but are always anxious about where their next meal is coming from. Important to address physical security and food insecurity first. Otherwise they won’t be good participants in any HIV/ART program or any other prevention program.
We hypothesize that for many people in resource-limited and other stressful environments, these syndromes do not represent true mental disorder but rather a normal stress response to an abnormal and stressful environment, partially or largely caused by food insecurity. Similarly, in such environments many substance users may not be physically addicted to alcohol or drugs, but may be self-medicating. Our conceptual model hypothesizes that providing temporary food security will afford individuals a window of opportunity that will enable actions resulting in longer term improvements in mental, physical, and social health. These actions include seeking and responding to mental health counseling, resulting in temporary improvements in many components of health and function (examples listed in box in Figure 2). Improved health and function, in turn, results in longer term enhancement of food security. The effect of a short-term food support intervention would therefore be maintained after the intervention ceases because resulting long-term improvements in mental health and food security feeds back to continued improvements in health and function (both mental and physical) which continue to enhance food security.