Disease prevention literature from SLMA

The Sri Lanka Medical Association SLMA under its new president for this year 2009 would take a disease prevention step of issuing patient information literature on public understanding of diseases.

So said Prof. Vidyajothi Prof. Rizvi Sheriff, in his induction address in the office of President SLMA held at the Mahaweli Centre in Colombo on Monday.

He said: I wish to have activities to enhance medical professionalism ethical practice of medicine, patient centered approach and encouraging team effort between health professionals and to strengthen the necessary harmony between doctors and other allied health staff.

A contribution to the public would be the creation of a tri-lingual compendium of SLMA vetted and approved patient information literature leaflets to aid patient and public understanding of diseases and procedures in medical care distributed to hospitals and practices to involve patients & relatives to understand illness.

We plan to integrate our activities towards creating awareness, in the profession and in the public of the rising epidemic of chronic in society.

The challenges

The WHO has listed the Regional Health Situation in 2007.

The challenges are identified in 5 domains viz Health Systems, Healthy Life course, Healthy Environments, Tackling NCDs and eliminating Communicable diseases.

I have chosen to talk on some aspects of Non Communicable Disease and the challenges this poses to the Sri Lankan society drawing on the global experiences.

I have been a doctor from 1971. I have personally witnessed great changes in the type of illness we have treated from the time we were students viz in the last 40 years. This is referred to as Epidemiological Transition.

The world has faced the challenges posed by communicable diseases for centuries. This list is from the latest Notifiable disease released by our Epidemiology Unit website in Sri Lanka/SL. Some illnesses such as Small Pox is now eradicated and off the list.

The WHO list of non communicable disease list out CVD, Stroke, Cancer, Diabetes, COPD, Mental Disease & Trauma amongst a large array of other conditions. The listed ones mentioned are the bigger problems the society has to grapple with. This is true for Sri Lanka as well.

The word Epidemic is commonly used for acute infectious diseases. The WHO uses the word even in the chronic disease setting largely because of the enormity of the numbers at risk.

Morbidity in the community

The Annual Health Bulletin of our Ministry of Health reports morbidity of inpatients in state hospitals. Remember we don’t have a statistic on morbidity in the community.

The yellow highlights pick out the significant problem chronic disease and the red ones the acute illnesses which are major problems with respect to severity and fatality.

In briefly outlining my programme of work for this year, in addition to having an exciting scientific programme at the academic sessions in March 09 other activities contributing to CPD or continuous professional development at Wijerama House and with outstation clinical societies will fill the calendar.

Professor Sir Roy Calne world renowned Professor of Surgery at the Cambridge University has agreed to be our Chief Guest. Professor Gavin Becker President of the Asia Pacific Society of Nephrology and the Professor of Nephrology at Melbourne University will be a Guest of Honour. I plan to focus on the Chronic Kidney Disease Epidemic of unknown etiology in the different provinces of our country as a special theme.

As a Councillor of the International Society of Nephrology I have been successful in enthusing a team of world leaders in kidney disease to come as a delegation from the COMGAN which is the Commission for the Global Advancement of Nephrology to have a joint meeting with the Ministry of Health, WHO team which is looking at the chronic kidney disease epidemic in the North Western, North Central and Uva Provinces of Sri Lanka.

In addition to this renal focus many other areas of importance to doctors and specialists is planned.

Vidyajyothi Professor Lalitha Mendis, Immediate Past President of the SLMA, Councillors of the SLMA, Officials of the Board of Trustees of the SLMA, Past Presidents, President elect for 2010 Professor Narada Warnasuriya, members of the SLMA, officials of the Ministry of Health, the WHO, National Science Foundation and representatives from other government, non-government organisations and other medical professional associations, members of the pharmaceutical industry, trade unions, student members, invitees and friends, I wish to thank all of you for gracing this occasion which is of special significance to my life and to the SLMA.

To be the President of one of the oldest medical associations in South Asia is no small honour. SLMA is now 122 years old, I have humbly accepted this office hoping to make a useful contribution during my year. I am very grateful to Dr. Dennis Aloysius & Prof. A.H. Sheriffdeen for initially promoting me to accept this position this year and council and membership for electing me.

Congratulates

Vidyajyothi Professor Lalitha Mendis, let me congratulate you on a wonderful activity filled 2008 for the association.

The SLMA owes you a great deal for the enormous job of work you did in 2008 touching every facet of SLMA activity starting from organizing the first corporate plan, amending the Constitution, in addition to the usual academic and social activities and the outstation meetings you conducted in grand style.

Your output is indeed a hard act to follow as you are a perfectionist and taskmaster but in my own style I promise to continue the good work you have started and add to it some things I have in mind. I’m sure the new council and the SLMA staff and members will rally round the efforts in 2009. I must also thank you for the generous introduction, which you have showered on me.

I must again thank the outgoing council members and the past presidents for having the confidence in me to place such a responsible task in my hands.

Fat and weight control

DR. D.P. ATUKORALE

“A round man cannot be expected to fit in a square hole right away. He must have time to modify his shape” (Mark Twain in ‘More Tramps Abroad’).

There have been times and places in history when being fat was considered beautiful especially in Asian countries like Sri Lanka and India.

In majority of Sinhala, Tamil and Hindi films screened in Sri Lanka during the period 1945 to 1960, the chief actress was a fat person and in most of these films fat females were selected for the major roles.

Of course, there were few exceptions such as Rukmani Devi, Nutan and Nargis.

Todays society however does not view fat pounds with pride.

Thin is in. It is the wallowing person who is seen as beautiful, socially acceptable and appealing to the opposite sex. Those of us with bulges and bumps will knead and pound, use saunas and starve ourselves anything to lose a pound.

Today entrepreneurs in USA make over 30 billion US dollars a year from America’s desire to be thin. Any book with a catchy new diet that promises quick weight loss becomes an overnight success in USA. Many of the millions preoccupied with weight control will be unable to resist any product or method that guarantees a quick result.

In spite of these attitudes and values, there is evidence to show that America has gained weight. About 58 million people (about one third of adult population) have added an average of about 10 pounds in the last decade.

Other data from the last 20 years show that there is an increase in child and adolescent obesity as well. These findings are not unique to USA but common to other developed countries and to the urban areas of developing countries such as Sri Lanka where due to changes in lifestyles and high calorie diet consumed by the affluent and rich class, obesity among adults adolescents and children is becoming more and more common.

In the rural areas of Sri Lanka where lifestyles and diets are different from those in urban areas, obesity is not a problem at present.

Weight goes up with age

Weight gain is more as you grow older. For USA, in women highest rates of overweight occur at age of 50 to 59. For USA men highest rates are at age 50 to 67 years. 42% at this age are overweight.

Obesity in childhood leads to obesity in adulthood in a high percentage of cases. About 75% of obese adolescents become obese adults and they are often fatter than those who become obese as adults.

What is obesity (overweight)

Obesity is a chronic medical condition caused by a variety of psychological and behavioral factors. Many obese people are genetically programmed to process and store fat too efficiently for the body’s needs.

Others have learnt to eat in response to inappropriate cues (such as stress, anxiety, boredom or depression) rather than genuine hunger.

A sedentary lifestyle is another frequent cause. In most obese people, a combination of these factors is at work.

NCHS research emphasises irregular and inadequate levels of physical activity, habit of eating more food away from home. One theory given for the increase in weight gain is that too little sleep may cause weight gain. It is said that many people in industrialized countries get less sleep than 30 or 40 years ago and many get up with even less sleep.

Alcohol also plays an important role in adding weight and consumption of alcohol is increasing in Sri Lanka and there is evidence to show that alcohol may promote fat storage in much the same way as fat.

Obesity gene

Discovery of an obesity gene recently is an advance in our knowledge of the physiology involved in weight gain.

In spite of obese people reducing fat intake, obesity has not come down significantly. Calories still count and the fat is often replaced with large amounts of sugar.

Types of obesity

Mild obesity is defined as weight of 20% over ideal weight. Those who are 30% to 40% over are diagnosed as moderate obesity and those over 40% are considered severely obese. There can be mistakes in this type of classification as muscles weight more than fat. As a result the ideal weight for someone who takes exercises regularly and is muscular may be higher than for a sedentary person.

Fat distribution

Some people especially men tend to deposit fat around the abdomen leading to apple shape. Abdominal obesity increases the risk of diabetes, heart disease, stroke and hypertension. Abdominal obesity also lowers HDL (good) cholesterol levels and elevates triglycerides (another type of fat found in the blood).

Other people especially women tend to deposit fat around buttocks, hips and thighs. But this tendency alone does not lead to harmful complications as in case of abdominal obesity. Majority of non-insulin dependant diabetes (NIDDM) can be attributed to obesity as can two-third of coronary heart disease cases and a tenth of breast and colon cancer.

Who should lose weight?

People who have medical conditions associated with obesity can clearly benefit from weight loss. Those with abdominal obesity can clearly benefit from shedding excess pounds. People who are merely overweight need not reduce for medical reasons.

Even modest weight reduction can bring on striking health improvements. Maintaining a balanced low fat diet, shedding excess pounds slowly, increasing your level of exercise and becoming aware of the cues that stimulate inappropriate eating are the keys of success.

A diet with 1,200 calories per day (with no more than 30% from fat) is usually restrictive enough to permit it success without jeopardizing health.

An exercise program often built around a comfortably placed 20 minute walk, three to four times a week is also essential. You also can increase your activity level by taking the stairs instead of escalators.

Before beginning to weight loss, you must always see your family physician to rule out medical conditions (such as endocrine disorders) and identify medications (such as steroids and tricyclic antidepressants) that can contribute to weight gain. He or she can advise you on how to exercise safely based on your medical history and may refer you to a dietician for nutritional counselling.

Medications for weight loss

While drug therapy is not a first line treatment, prescription of diet medications (known as anorectics) are sometimes recommended. As far as I know all anorectics have side effects and should be taken only if your family physician prescribes these and should be used only after dieting has failed in patients who are severely obese or in those who have medical conditions that require weight loss. Two most frequently used drugs are penfluramine and phentermine. Both enhance the release of serotonin (a chemical that promotes satiety).

What is to be done?

What needs to be done is to prevent weight gain and not to lose after it has accumulated, says F. Xavier Pisunviyer MD of NIH Obesity Research Center, ST. Lukes - Roosvelt Hospital, N.Y. NCHS investigations give two warnings, firstly even though weight loss products and services cost a lot of money (30-50 billion dollars annually in USA) they are not very effective. Secondly increasing concern about obesity (overweight) can promote increase in eating disorders. They suggest counselling both overweight and normal weight people to limit gain, increase physical activity and consume diets lower in fat and sugar.

In the presence of other risk factors such as diabetes, hypertension, smoking and hypercholesterolaemia, dieting must be attempted and can produce deserved results. Others claim that it is far wiser to focus on lifestyle changes rather than weight loss, on health rather than on total weight.

Thus phylosopy espouses empowerment to increase self-awareness and effect gradual change which is more likely to be permanent. Serious health risks associated with Yo-Yo dieting seem to be unwarranted following a recent review of research as the report “Theories on Yo-Yo Dieting Unwind” indicates.

Courtesy: Nutrition 8th Edition By C.C. Cook Fuller and Slephen Barret MD

The importance of functional foods in your child’s life

Sent by Mithu Kingsley

Every mother knows the importance to ensure that her child eats the right food. The growing up years are crucial and sets the foundation for healthy growth and development. Growing children such as toddlers and pre-schoolers require an increased amount of energy and nutrients for their active lifestyle.

However, good nutrition alone is not enough. Proper absorption is just as important. Recent nutritional breakthroughs have helped in the development of “functional foods” which produce specific health benefits. Functional foods such as Prebiotics can be added as a food supplement to food to give specific health benefits.

Since children are generally poor eaters and have very small appetites, ensuring that they get the required nutrients in their food becomes critical.

It is important to provide them with the correct nutrient dense foods i.e. those that supply plenty of nutrients in a small volume of food.

This will ensure proper growth and development.

What are Prebiotics?

Prebiotics are non-digestible natural food ingredients (normally a carbohydrate) that can beneficially affect and improve children’s health by promoting a healthy digestive system. This will help to better absorb nutrients such as protein, vitamins, iron and calcium, all of which are essential to build a healthier body and mind in growing children.

The addition of Prebiotics also reduces harmful bacteria in the stomach, the risk of infectious diarrhoea and likelihood of constipation.

This will help growing children grow smarter and stronger faster.

Genetic code an open book

Once impenetrable, the individual genetic code is becoming an open book thanks to kits that scan for genes linked to scores of traits and diseases, from cancer and baldness to infertility and memory loss.

A couple of hundred dollars, a few drops of saliva and a stamped envelope is all it takes to get a rundown on your inherited risk of around a hundred more-or-less common conditions. You can place your order by Internet.

Business is booming even as some experts raise red flags about the tests, challenging their accuracy and questioning the wisdom of satisfying the growing hunger for intimate genetic knowledge.

Leading the pack of start-ups is California-based 23andMe, which offers “to help others take a bold, informed step toward self-knowledge”.

Rival deCODEme, a subsidiary of Iceland firm deCODE, promises “the discovery of your genetic propensity for developing specific diseases and conditions”.

Navigenics in Redwood Shores, California says it can “help you live healthier, longer”.

The business is called personalised genomics, and it is only now starting to deliver on a long-heralded promise.

Within a decade, say its supporters, mapping one’s complete genetic landscape will be as quick and common as a blood test for cholesterol.

Already today, women can check for a faulty variant of two genes, BRCA 1 or 2, that boosts the chance of getting breast cancer by 50-80 percent.

Other tests scan for the likelihood of sexual dysfunction brought on by certain anti-depressants, or heightened odds of becoming obese, schizophrenic or diabetic.

Parents can scan for diseases in their children even when they are barely-fertilised embryos.

Last week saw the birth of the first baby in Britain grown from an embryo screened to ensure it did not contain the same breast cancer-causing gene inherited by her mother.

Another test is designed to spot athletic potential, and help figure out if junior could be the next Usain Bolt or just an also-ran.

The kit, marketed in the US by Atlas Sports Genetics, checks for either of two variants of the ACTN3 gene.

One gives rise to so-called “fast-twitch muscles” common among world-class sprinters, while the other produces the slow-twitch version found among endurance athletes.

Not all the genetic secrets waiting to be unlocked are critical or even secret.

A sweet tooth, wet ear wax, heightened sensitivity to bitter greens or a slightly porous memory are hardly life-altering discoveries.

Why now? The science behind gene testing is not new.

What has changed, and rapidly, is the cost of technology.

All these tests have a high degree of uncertainty Since the three-billion-dollar Human Genome Project was completed in 2001, sequencing an individual’s genome “has become an order of magnitude cheaper and faster” every couple of years, Lynda Chin, a researcher at the Dana-Farber Cancer Institute in Boston, said in an interview.

The price tag today is about 100,000 dollars, and at least one company, Pacific Biosciences in Menlo Park, California, says it will be able, by 2013, to map all three billion base-pairs of a person’s DNA in a quarter of an hour for a few hundred dollars.

But not everyone is ecstatic.

To start with, the tests available to date are only snap shots of a DNA snippet, not the whole shebang. More critically, the data they yield is subject to interpretation.

PARIS, Friday AFP

Cancer at specific steps

In women with a BMI of 34 or greater, the risk of developing endometrial cancer is increased by more than six times.

Studies have consistently shown a positive association between obesity and colorectal cancer in men and a two fold increased risk among premewnopausal women There is increasing evidence that women who are overweight and obese, especially those who gain weight throughout adulthood, are at an increased risk for developing breast cancer after menopause.

Men with the highest levels of obesity have nearly doubled the risk for renal-cell cancer.

Obesity can cause acid reflux, which is associated with esophageal cancer, and excess weight is associated with gallstones, which can increase gallbladder cancer risk.

Courtesy Slimlife