Hidden hunger in patients with type 2 diabetes (T2D) and its effect on glycaemic control: a protocol for systematic review and meta-analysis.

INTRODUCTION: Hidden hunger or micronutrient deficiencies are quite common in many parts of the world, particularly in the countries of sub-Saharan Africa and South Asia. Micronutrient deficiencies may impact insulin signalling pathways and glucose metabolism, potentially accelerating the onset and development of type 2 diabetes (T2D). This review aims to estimate the prevalence of multiple micronutrient deficiencies among patients with T2D and assess the effect of their deficiency on glycaemic control. METHODOLOGY: The review follows the Cochrane Handbook and PRISMA 2020 guidelines. It includes all eligible studies reporting the prevalence of micronutrient deficiencies and their effect on glycaemic control in T2D patients. We would undertake a comprehensive literature search across databases: PubMed, Scopus, EMBASE, LILACS, ProQuest, Google Scholar and grey literature, and identify the studies meeting the inclusion criteria. We would perform data extraction using a prepiloted data extraction sheet and record relevant study characteristics and outcomes. ANALYSIS: Data will be analysed using JBI Sumari software and R software. Pooled prevalence/incidence of micronutrient deficiency will be estimated, and variance will be stabilised using logit transformation and a double-arcsine transformation of the data. The OR and risk ratio of glycaemic control among T2D cases with and without micronutrient deficiency will be estimated using the 'rma' function under the 'meta' and 'metafor' packages.The study findings will have implications for diabetes management strategies and may inform interventions targeting improved glycaemic control through addressing micronutrient deficiencies. ETHICS AND DISSEMINATION: This systematic review will be based on the scientific information available in the public domain; therefore, ethics approval is not required. We will share the study findings at national and international conferences and submit them for publication in relevant scientific journals. PROSPERO REGISTRATION NUMBER: CRD42023439780.

Longitudinal experience of food insecurity & cigarette use in the early COVID-19 Pandemic, United States.

Food insecurity is associated with cigarette smoking, yet little is known about how variability in the experience of food insecurity may relate to patterns of cigarette use. We sought to examine patterns of food insecurity and cigarette use during the COVID-19 pandemic (April 2020-March 2021). We analyzed longitudinal survey data from a nationally representative panel of adults in the United States (N = 7,880) from the Understanding Coronavirus in America Study. The primary independent variable was ten trajectories of food insecurity. Our dependent variable was past 7-day cigarette use (count of days used cigarettes). Poisson regression using generalized estimating equations was run controlling for key covariates. The prevalence of cigarette use on at least one day in the past week was lowest (17.5 %) for those who Remained Food Secure, and highest (57.9 %) among those who Became Fully Food Insecure, a group characterized by having high probability of becoming food insecure during the study period. Among those who reported at least one day of cigarette use in the past week, fewer than half (40.1 %) reported sustained use across all waves of the study. Those who Became Fully Food Insecure had an incidence rate ratio (IRR) of 1.73 (95 % CI: 1.18, 2.54) compared to those who Remained Food Secure with respect to number of smoking days. While different patterns of food insecurity are related to cigarette smoking at the population level, these results highlight that food insecurity, a key social need, may represent a novel strategy for informing reduction of tobacco use disparities.

Migration of the os peroneum: An enigmatic phenomenon explored through radiological perspectives.

The os peroneum is an accessory ossicle located along the lateral aspect of the cuboid bone. Its position can serve as an indicator of peroneus longus tendon (PLT) injury. Imaging studies including radiographs and MRI can help detect malposition of the os peroneum and progressive injuries to the PLT and its associated structures. We report a case of a woman with recurrent foot and ankle pain, demonstrating progressive retraction of the os peroneum, implying severe PLT injury which may have ultimately predisposed her to a traumatic fifth metatarsal base fracture. This case highlights the importance of scrutinizing the appearance and position of the os peroneum on radiographs.

Migration Spurs Changes in the Human Microbiome: a Review.

International migration often results in major changes in living environments and lifestyles, and these changes may lead to the observed increases in obesity and diabetes among foreign-born people after resettling in higher-income countries. A possible mechanism linking changes in living environments to the onset of health conditions may be changes in the microbiome. Previous research has shown that unfavorable changes in the composition of the microbiome can increase disposition to diseases such as diabetes, obesity, kidney disease, and inflammatory bowel disease. We investigated the relationship between human migration and microbiome composition through a review using microbiome- and migration-related search terms in PubMed and Web of Science. We included articles examining the gut, oral, or oropharyngeal microbiome in people who migrated internationally. Nine articles met eligibility criteria. All but one examined migration from a non-Western to a Western country. Four of these found a difference in the microbiome of migrants compared with non-migrating residents of their country of birth, seven found differences in the microbiome of migrants compared with the native-born population in the country of resettlement, and five found microbiome differences associated with duration of stay in the country of resettlement. Microbiome composition varies with country of birth, age at migration, time since immigration, and country of resettlement. The results suggest that migration may lead to changes in the microbiome; thus, microbiome characteristics are a plausible pathway to examine changes in health after resettlement in a new country.

Evaluation of total glutathione-s-transferase levels in serum of patients with oral malignancy.

Introduction: Squamous cell carcinoma-related antigen is not always sensitive enough for the early detection of oral cancer which is why a new marker has been desired as a substitute to be applied for serum diagnosis of oral cancer. Reactive oxygen species (ROS) has been known to play an important role in carcinogenesis. Glutathione-s-transferases (GSTs) are a family of eukaryotic and prokaryotic phase-II metabolic isoenzymes involved in xenobiotic detoxification. This correlation of the ROS species function and their role in initiation and progression of cancer could be exploited as of diagnostic value. The biologic function of the GSTs in human head-and-neck squamous cell carcinomas has been studied by researchers at gross as well as molecular levels. Taking into consideration this scientific background, future scope and perspectives, we initiated this study. Materials and Methods: This study was performed as a prospective case-control in vitro analytical study with subjects (n = 40) fulfilling the prerequisite conditions and were compliant. The case group (n = 20) was subjects with histopathologically proven cases of oral malignancy and age- and sex-matched control group (n = 20). The enzyme GST was evaluated in sera of all participants and then comparison was done between two groups as well as correlation with histopathologic grading for oral malignancy. Results: The mean serum GST activity in oral cancer patients was significantly higher than that of the control group. The present study has compared the alterations of enzyme in relation to histopathological grading of oral malignancy and found increased serum GST activity of well-differentiated and moderately differentiated carcinomas than the poorly differentiated carcinoma in terms of mean. Conclusion: Increased expression of the enzyme, as reported in the present study, can be due to tumor burden which attributes to overproduction of GST by cancer cells. The major clinical significance of the present study is that it gives important information regarding a new tumor progression and prognosis marker.

Surface Activity and Aggregation Behavior of Polyhydroxylated Fullerenes in Aqueous Solutions.

Polyhydroxylated fullerene (PHF) surface activity and aggregation behavior at the air-water interface were examined using surface tension and resonance-enhanced second harmonic generation (SHG). Surface tension data showed that PHFs are surface active with a limiting surface excess corresponding to 130 Å2/molecule in aqueous (Millipore water) solutions. Increasing the solution-phase ionic strength (through the addition of NaCl) reduces the PHF surface excess. Conductivity measurements show that PHFs carry a single charge, presumably negative. Surface-specific SHG experiments show a small but measurable fixed wavelength, nonlinear response from solutions having surface excess coverages as low as ∼400 Å2/molecule. The SHG response of PHF solutions in the low-concentration limit shows unexpected behavior, implying that at bulk concentrations below 0.06 mg/mL, PHF monomers adsorb to the surface and interfere destructively with the intrinsic nonlinear susceptibility of the aqueous/vapor interface, leading to a ∼75% reduction in the SH signal. Above a PHF concentration of 0.0.06 mg/mL, the SH signal begins to rise in the Millipore and 50 mM NaCl solutions but remains very low in the 500 mM NaCl solutions. From this behavior, we infer that an increased nonlinear optical response is due to adsorbed aggregates.

Carbon Nanoparticle-Induced Changes to Lipid Monolayer Structure at Water-Air Interfaces.

Surface specific vibrational spectroscopy experiments together with surface tension measurements and spectroscopic ellipsometry data were used to characterize the effects of soluble carbon particulates on compressed and partially compressed lipid monolayers adsorbed to the water-air interface. The lipid monolayers consisted of 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DPPC), and measurements were made for both tightly packed monolayers (40 Å2/molecule) and monolayers in their liquid condensed state (55 Å2/molecule). Langmuir trough data show that very small amounts of PHF (0.0075 mg/mL or 6.4 × 10-6 M) decrease lipid film compressibility. This finding supports a cooperative adsorption mechanism whereby the soluble PHFs are drawn to the surface and associate with the insoluble DPPC monolayer. Excess free energies (ΔGmixE) were positive, consistent with the cooperative adsorption mechanism, and although the excess free energies are small (≤1 kJ/mol), adsorbed PHF has measurable effects on monolayer structure. Further support for the cooperative adsorption mechanism at the water-air interface comes from vibrational sum frequency generation (VSFG) experiments. Low PHF concentrations (≤0.06 mg/mL) increase DPPC acyl chain ordering in liquid condensed lipid films and decrease DPPC acyl chain ordering and film thickness in tightly packed lipid films.

Food Choices in the Context of Globalizing Food Options among Adolescents in Rural Southern India.

Changes in food choice often accompany globalization and economic growth. These changes have not been well documented in rural settings and among young people. To advance research on food choice, we demonstrate adolescents' selection of local vs.non-local foods in a rural area of India where globalization is just reaching. A representative sample of 237 school-going adolescents in a village in Southern India completed a survey in 2019 to understand how adolescents decide among foods traditional to the area and foods arriving from other parts of the country and the world. Adolescents most frequently consumed local foods but also occasionally consumed non-local items. In hypothetical scenarios, 81% of the adolescents reported being most interested in substituting local foods with non-local foods if they were to have more money. Among the few who currently consumed non-local snacks and drinks, very few would be willing to replace them with local alternatives, particularly if they were to have more money (snacks: 10% and drinks: 5% respectively). Overall, adolescents were most interested in switching to non-local items when considering fruits, vegetables and snacks. As India faces the dual burden of undernutrition and overnutrition, understanding the changing food environment may help inform efforts to improve nutrition.

Toward 'element balance' in ADHD: an exploratory case control study employing hair analysis.

Background: Head hair analysis has been used for decades to clarify mineral relationships to symptoms of ADHD, but there is little consensus among findings. We sought to explore 33 hair element concentrations and their 528 calculated ratios among two groups of boys, one with ADHD and one without.Method: 107 boys aged 7-12 years were recruited; 55 with ADHD and 52 non-ADHD Controls. Hair minerals were compared using Mann-Whitney U tests, p<0.01 was used for significance. Dietary data were obtained using a 138 item food frequency questionnaire (FFQ).Results: There were three group differences on individual elements: bismuth/Bi: 8 fold higher in ADHD, chromium/Cr: 15% lower in ADHD and germanium/Ge: 11% lower in ADHD, Cr level being the strongest predictor of ADHD symptoms. We found thirty significant group differences in element ratios, two thirds involving Bi and eight of these showing that as ADHD severity increased, the ratios with Bi as the denominator decreased (r ranging from -0.263 to -0.433, p<0.01). From the FFQ, tinned fruit was consumed more often in the ADHD group. Hair arsenic levels were somewhat elevated across both ADHD and Control groups.Discussion: While element 'imbalance' appears to be associated with ADHD, we did not replicate any previous study results of group differences on individual elements. We have raised the possibility that the ratios may be far more important than any one individual element in better elucidating the effects that minerals may have on the pathogenesis of ADHD. These are cautionary findings requiring replication.

Eating habits and sleep patterns of adolescents with depression symptoms in Mumbai, India.

Adolescents with depression engage in unhealthy eating habits and irregular sleep patterns and are often at an increased risk for weight-related problems. Improvement in these lifestyle behaviours may help to prevent depression, but knowledge about the associations between depression, sleep, eating habits and body weight among adolescents in India is limited. This cross-sectional study investigated the prevalence of depression and its association with sleep patterns, eating habits and body weight status among a convenience sample of 527 adolescents, ages 10-17 years in Mumbai, India. Participants completed a survey on sleep patterns such as sleep duration, daytime sleepiness and sleep problems and eating habits such as frequency of breakfast consumption, eating family meals and eating out. Depression was assessed using the Patient Health Questionnaire modified for Adolescents (PHQ-A). Anthropometric measurements were also taken. Within this sample, 25% had moderate to severe depression (PHQ-A ≥ 10) and 46% reported sleeping less than 6 h > thrice a week. Adolescents with moderate to severe depression had significantly higher body mass index than those with minimal depression (26.2 ± 6.6 vs. 20.2 ± 4.8 kg/m2 ). The odds of having clinically significant depression (PHQ-A ≥ 10) was 4.5 times higher in adolescents who had family meals ≤ once a week, 1.6 times higher among those who were sleeping <6 h and 2.3 times higher among participants having trouble falling to sleep more than thrice a week. The findings indicated that a significant proportion of adolescents had depression symptoms; improving sleep and eating habits may present potential targets for interventions.

Single-pill Combination of Empagliflozin and Linagliptin in Real World Indian Type 2 Diabetes Patient (GRID).

INTRODUCTION: For the recently introduced single-pill combination of empagliflozin and linagliptin, real-world evidence has not been available. This observational study aims to assess real-world effectiveness of this combination, in the Indian outpatient setting of type-2 diabetes. METHODS: This was a prospective cohort study design, involving patients from 4 centres across western India. Patients with type-2 diabetes and uncontrolled HbA1c, were categorized into 4 groups, including: (1) Naïve to DPP-4i or SGLT-2i; (2) Receiving DPP-4i; (3) Receiving SGLT-2i; (4) Receiving SGLT-2i and DPP-4i as individual pills. Patients were initiated on the fixed-dose combination of empagliflozin + linagliptin, and followed-up over 12-week duration. Clinical parameters of changes in glycaemia, body-weight, and blood-pressure were observed. RESULTS: 251 patients were included in the analysis, with just over half of them being males (57%), or having pre-existing cardiovascular disease (54%). The group-wise patient distribution was approximately 47%, 18%,15%, and 20% respectively. The study represented patients across broad range of duration of type-2 diabetes, use of background antidiabetic therapies, and comorbid cardiovascular risk. The use of combination demonstrated significant and clinically meaningful reductions in HbA1c, fasting and postprandial glycaemia levels across all the study groups. Reductions in body-weight and blood-pressure levels were also demonstrated. Interestingly, patients in group 4, who were switched from free drug combination to the fixed-dose combination, also demonstrated significant and meaningful improvements in HbA1c, fasting as well as postprandial glycaemia levels, suggestive of possible improvement in medication-adherence. CONCLUSION: This real-world evidence complements the results observed in randomized controlled trials, for meaningful effectiveness with the use of empagliflozin-linagliptin fixed dose combination in the Indian outpatient setting. More evidence may facilitate further characterization of clinical value of this promising combination.

Study of Beneficial Impact on Specific Biomarkers in Type 2 Diabetes During Ramadan Fasting (Unintentional Intermittent Fasting).

BACKGROUND: Fasting during the holy month of Ramadan is observed by Muslims worldwide as it accounts for one of the five pillars of the religion Islam. We speculate the fasts observed during the month of Ramadan to be unintentional intermittent fasts, which may have health benefits. OBJECTIVE: The study was attempted to know the alterations in biomarkers viz. body weight (BW), body mass index (BMI), serum glycated haemoglobin (HbA1c), systolic and diastolic blood pressure (SBP and DBP) due to Ramadan IF on type 2 diabetes (T2D) patients of western India. METHODS: A total 50 patients of T2D were selected for above-mentioned biomarkers assessment immediately before the starting of fast followed by after 45 days. RESULTS: The present results indicated the beneficial impact on intermittent fasting among patients (baseline versus followed up) by detecting the alterations of above-mentioned biomarkers. In overall results (n=50), the BW (Kg) and BMI (Kg/m2) values were significantly (P<0.001) decreased in followed-up patients (76.06 ± 15.41 and 27.45 ± 5.06) when compared to baseline value (77.26 ± 15.53 and 27.90 ± 5.11) while the level of HbA1c (mmol/mol) was also significantly (P<0.05) decreased in followed-up patients (7.62 ± 0.99) when compared to baseline value (7.90 ± 1.24). But no significant changes in the values of SBP and DBP were observed. CONCLUSIONS: In conclusion, this observational study revealed the reduction of body weight, BMI and serum HbA1c levels probably due to IF for the T2D patients during the holy month of Ramadan. Moreover, the IF can be utilized as a therapy along with other pharmacological therapies. It is suggested future research work with other important biomarkers, which can be easier for T2D therapy.

Health and Demographic Surveillance Systems Within the Child Health and Mortality Prevention Surveillance Network.

Health and demographic surveillance systems (HDSSs) provide a foundation for characterizing and defining priorities and strategies for improving population health. The Child Health and Mortality Prevention Surveillance (CHAMPS) project aims to inform policy to prevent child deaths through generating causes of death from surveillance data combined with innovative diagnostic and laboratory methods. Six of the 7 sites that constitute the CHAMPS network have active HDSSs: Mozambique, Mali, Ethiopia, Kenya, Bangladesh, and South Africa; the seventh, in Sierra Leone, is in the early planning stages. This article describes the network of CHAMPS HDSSs and their role in the CHAMPS project. To generate actionable health and demographic data to prevent child deaths, the network depends on reliable demographic surveillance, and the HDSSs play this crucial role.

Healthfulness, Modernity, and Availability of Food and Beverages: Adolescents' Perceptions in Southern India.

This study uses freelists to document perceptions of healthfulness, modernity, and availability of foods and beverages among adolescents ages 13-18 years (n = 26) in urbanizing India. Among the 10 foods and beverages adolescents perceived as "new," half were also seen as modern and unhealthy, 4 as traditional and unhealthy, and 3 as modern and healthy. Of those 10 "new" foods, 4 were reported as available only in supermarkets, 4 only in kiraana (local) stores, and 6 in both. Adolescents ascribed healthfulness and modernity to food and beverage items and were aware of their availability across stores.

Development and evaluation of a Nutrition Transition-FFQ for adolescents in South India.

OBJECTIVE: To develop and evaluate a Nutrition Transition-FFQ (NT-FFQ) to measure nutrition transition among adolescents in South India. DESIGN: We developed an interviewer-administered NT-FFQ comprising a 125-item semi-quantitative FFQ and a twenty-seven-item eating behaviour survey. The reproducibility and validity of the NT-FFQ were assessed using Spearman correlations, intra-class correlation coefficients (ICC), and levels of agreement using Bland-Altman and cross-classification over 2 months (NT-FFQ1 and NT-FFQ2). Validity of foods was evaluated against three 24-h dietary recalls (24-HR). Face validity of eating behaviours was evaluated through semi-structured cognitive interviews. The reproducibility of eating behaviours was assessed using weighted kappa (κ w) and cross-classification analyses. SETTING: Vijayapura, India. SUBJECTS: A representative sample of 198 adolescents aged 14-18 years. RESULTS: Reproducibility of NT-FFQ: Spearman correlations ranged from 0·33 (pulses) to 0·80 (red meat) and ICC from 0·05 (fruits) to 1·00 (tea). On average, concordance (agreement) was 60 % and discordance was 7 % for food groups. For eating behaviours, κ w ranged from 0·24 (eating snacks while watching television) to 0·67 (eating lunch at home) with a mean of 0·40. Validity of NT-FFQ: Spearman correlations ranged from 0·11 (fried traditional foods) to 0·70 (tea) and ICC ranged from 0·02 (healthy global foods) to 1·00 (grains). The concordance and discordance were 48 % and 8 %, respectively. Bland-Altman plots showed acceptable agreement between NT-FFQ2 and 24-HR. The eating behaviours had acceptable face validity. CONCLUSIONS: The NT-FFQ has good reproducibility and acceptable validity for food intake and eating behaviours. The NT-FFQ can quantify the nutrition transition among Indian adolescents.

Going global: Indian adolescents' eating patterns.

OBJECTIVE: To describe adolescents' eating patterns of traditional, global/non-local and mixed foods, and the factors that may influence food consumption, access and preferences, in a globalizing city. DESIGN: A representative sample of school-going adolescents completed a cross-sectional survey including an FFQ designed to identify traditional and global foods. Student's t test and ordinal logistic regression were used to examine weekly food intake, including differences between boys and girls and between adolescents attending private and public schools. SETTING: Vijayapura city, Karnataka State, India. SUBJECTS: Adolescents (n 399) aged 13-16 years. RESULTS: Compared with dietary guidelines, adolescents consumed fruit, green leafy vegetables, non-green leafy vegetables and dairy less frequently than recommended and consumed energy-dense foods more frequently than recommended. Traditional but expensive foods (fruits, dairy, homemade sweets and added fat) were more frequently consumed by private-school students, generally from wealthier, more connected families, than by public-school students; the latter more frequently consumed both traditional (tea, coffee, eggs) and mixed foods (snack and street foods; P≤0·05). Girls reported more frequent consumption of global/non-local packaged and ready-to-eat foods, non-green leafy vegetables and added fat than boys (P≤0·05). Boys reported more frequent consumption of eggs and street foods than girls (P≤0·05). CONCLUSIONS: Adolescents' eating patterns in a globalizing city reflect a combination of global/non-local and traditional foods, access and preferences. As global foods continue to appear in low- and middle-income countries, understanding dietary patterns and preferences can inform efforts to promote diversity and healthfulness of foods.

Serum 25-hydroxyvitamin D concentrations are associated with prevalence of metabolic syndrome and various cardiometabolic risk factors in US children and adolescents based on assay-adjusted serum 25-hydroxyvitamin D data from NHANES 2001-2006.

BACKGROUND: The effect of assay drifts over time on serum 25-hydroxyvitamin D [25(OH)D] concentrations were not accounted for in previous national survey studies. Thus, previously reported associations between 25(OH)D with cardiometabolic risk factors using data from NHANES were likely over- or underestimated. Moreover, associations between serum 25(OH)D and metabolic syndrome (MetSyn), insulin resistance (IR), and inflammation are unclear in children. OBJECTIVE: The relation between serum 25(OH)D and cardiometabolic risk factors in US children was investigated by using updated 25(OH)D data. DESIGN: This study was based on newly updated serum 25(OH)D data, which were released by the National Center for Health Statistics in November 2010. Data from 3 cycles of NHANES (2001-2002, 2003-2004, and 2005-2006) for 5867 adolescents, aged 12-19 y, were used to study the association, by multivariate-adjusted regression, between serum 25(OH)D and prevalence of MetSyn and several cardiometabolic risk factors. RESULTS: The likelihood of having MetSyn was significantly higher in the first tertile of serum 25(OH)D than in the third tertile of 25(OH)D (odds ratio: 1.71; 95% CI: 1.11, 2.65; P < 0.01). Waist circumference (P < 0.0001), systolic blood pressure (P = 0.01), and homeostatic model assessment-insulin resistance index (P = 0.001) were inversely related and HDL cholesterol (P < 0.0001) was directly related with serum 25(OH)D. No association was observed between 25(OH)D and C-reactive protein (P = 0.18). CONCLUSIONS: On the basis of assay-adjusted data, serum 25(OH)D was significantly associated with several cardiometabolic risk factors regardless of obesity. In children, given the negative outcomes associated with poor vitamin D status and MetSyn, consideration of vitamin D supplementation in reversing cardiometabolic risk factors appears to be warranted.