Implementation of the International Code of Marketing of Breastmilk Substitutes in the Eastern Mediterranean Region

Background: Optimal breastfeeding practices and appropriate complementary feeding improve child health, survival and development. The countries of the Eastern Mediterranean Region have made significant strides in formulation and implementation of legislation to protect and promote breastfeeding based on The International Code of Marketing of Breast-milk Substitutes [the Code] and subsequent relevant World Health Assembly resolutions. Aim: To assess the implementation of the Code in the Region. Methods: Assessment was conducted by the World Health Organization [WHO] Regional Office for the Eastern Mediterranean using a WHO standard questionnaire. Results: Seventeen countries in the Region have enacted legislation to protect breastfeeding. Only 6 countries have comprehensive legislation or other legal measures reflecting all or most provisions of the Code; 4 countries have legal measures incorporating many provisions of the Code; 7 countries have legal measures that contain a few provisions of the Code; 4 countries are currently studying the issue; and only 1 country has no measures in place. Further analysis of the legislation found that the text of articles in the laws fully reflected the Code articles in only 6 countries. Conclusion: Most countries need to revisit and amend existing national legislation to implement fully the Code and relevant World Health Assembly resolutions, supported by systematic monitoring and reporting

Open-array analysis of genetic variants in Egyptian patients with type 2 diabetes and obesity

Background: Diabetes mellitus is considered a major public health problem worldwide. Susceptibility to diabetes is influenced by both genetic and environmental determinants

Aims/hypothesis: The aim of the present study was to test for 16 independent single nucleotide polymorphisms [SNPs] in established Type 2 diabetes [T2D] and obesity susceptibility loci by GWAS in a sample of Egyptian patients to find out if there is shared genetic background underlying both disease entities

Methods: Genotyping was performed using OpenArray protocol on the QuantStudio 12K Flex Real-Time PCR System. In the present case control study a custom array was designed to facilitate cost-effective analysis of selected SNPs related to glycolysis, gluconeogenesis, inflammation, insulin signalling, and immune function

Results: Seven gene variants showed significant association with the risk of T2D patients including FCGRA2, STAT4, CELSR2, PPARG, EXT2 rs3740878, GCKR, PTGS1. Factors that significantly affect T2D were obesity [p < 0.001] and GCKR [p = 0.001] and PTGS1 [p = 0.001] gene variants. Gene variants that showed significant or borderline effect on obesity were MTHFD1, EXT2 rs3740878, GCKR and PTGS1 [p = 0.03, 0.017, 0.059, 0.006] respectively

Conclusions/interpretation: Overlapping genetic aspects should be considered and the presence of risk alleles of different genes together could contribute to the risk of T2D or obesity or both. The MTHFD1 and EXT2rs3740878 gene variants significantly affect obesity and not shared with T2D. Gene variants that showed combined effect on both disease entities were GCKR and PTGS1. These findings provide a basis for future studies on a larger scale. More stress on the risk gene variants that have a combined impact on both diabetes and obesity is recommended to improve risk prediction and preventive strategies