more_vertLawrence Haddad and David Nabarro will be presented with the World Food Prize for work significantly improving nutrition. Talha Burki reports.
Preference: Nutrition
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Act now on climate change and health
Act now on climate change and health
The AMA has warned the Government not to ignore the future health implications of climate change.
Describing some details in the latest report from the Intergovernmental Panel on Climate Change (IPCC) as “worrying predictions for human health,” AMA President Dr Tony Bartone they simply must not be dismissed.
The just released report – Global Warming of 1.5°C, an IPCC special report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty – highlights the scientifically-based threats to human health that could occur if governments do not act to tackle climate change.
It states that limiting global warming to 1.5°C would require rapid, far-reaching changes in all aspects of society.
But limiting global warming to 1.5°C compared to 2°C could go hand in hand with ensuring a more sustainable and equitable society.
Dr Bartone said the report was consistent with AMA policy.
He added that it reiterated the scientific reality that climate change affects health and wellbeing by increasing the environment and situations in which infectious diseases can be transmitted, and through more extreme weather events, particularly heatwaves.
The IPCC has previously concluded that there is high to very high confidence that climate change will lead to greater risks of injuries, disease, and death due to more intense heatwaves and fires; increased risks of undernutrition; and consequences of reduced labour productivity in vulnerable populations.
“The 2018 report shows that the magnitude of projected heat-related morbidity and mortality would be even greater with global warming at 2°C than by limiting global warming at 1.5°C,” Dr Bartone said.
“The impact on human life is significant. The AMA urges the Government to seriously consider these predictions, and act accordingly.”
According to the Appendix of the 2018 IPCC Report:
- Years of life lost due to heat-related illness in Brisbane are projected to increase from 616 in 2000, to 1178 at 1.5°C, and then to 2845 at 2°C.
- In Australia’s five largest cities, with estimated population change, heat-related deaths are projected to increase from a baseline of 214 per year, to 475 per year at 1.5°C, and to 970 per year at 2°C.
Other impacts at 1.5°C compared to 2°C include:
- A higher increase in ozone-related mortality.
- A higher risk of malaria due to an expanded geographic range and season of the anopheles mosquito.
- A higher risk of dengue, yellow fever, and Zika virus due to an increased number and range of the aedes mosquito.
- A more significant increase in vector-borne disease transmission in North America and Europe, including West Nile Virus and tick-borne diseases.
The IPCC report cites 6,000 scientific references, includes the contribution of thousands of expert and government reviewers worldwide, and was prepared by 91 authors and review editors from 40 countries.
JOHN FLANNERY and CHRIS JOHNSON
The AMA Position Statement on Climate Change and Human Health is at position-statement/ama-position-statement-climate-change-and-human-health-2004-revised-2015
Hidden salt in bread still a challenge for consumers
Australia’s biggest independent bakery chain says it’s unlikely to adopt proposed salt reduction targets aimed at improving the nation’s cardiovascular health, citing factors such as ‘oven spring’.
Stakeholders were given until last week to comment on the Federal Government’s proposed Voluntary Food Reformulation Targets for bread, which have been developed together with industry through the Healthy Foods Partnership.
A maximum target of 380mg of sodium per 100g has been proposed for leavened breads, to be achieved by the end of 2022. A separate target of 450mg/100g has been proposed for flat breads.
The consultation paper notes bread is a major contributor to Australians’ excess dietary sodium intake.
“Reducing sodium intake can reduce blood pressure, thereby reducing the risk of cardiovascular disease,” it says.
However, a spokesman for Bakers Delight, which has 13.6% of the Australian bread market share, told doctorportal the proposed sodium target would have “too much negative impact” on the flavor and structure of its breads.
“Salt is an essential part of [bread’s] delicious flavour, helps regulate the fermentation process and strengthens the gluten matrix. Without salt, the dough becomes very unstable and is unlikely to hold its structure and shape when baked. It can also lead to an uneven crumb structure and less ‘oven spring’,” the spokesman said.
Bakers Delight advertises the kilojoule count for its products in store, but the sodium content can only be found by visiting the company’s website. Its Hi-Fibre Lo-GI block loaf, marketed for school lunches, contains 532mg of sodium/100g, while its healthier Wholemeal Country Grain block loaf contains 475mg of sodium/100g. The company’s lowest salt bread – the Cape Seed loaf – meets the draft targets with 297mg of sodium/100g, but it’s also much more expensive than other products, at $6.30 a loaf.
Bakers Delight said it had reduced the sodium content of its breads in recent years.
“Traditionally, Australian bakers have worked to a ‘2% of flour weight’ ratio however since 2012, we have used a 1.8% ratio,” the spokesman said. “We’ve also implemented an average 15% salt reduction across our Sourdough and Soy and Linseed range.”
Nevertheless, its Sourdough Vienna loaf still contains 625mg of sodium/100g.
It’s a similar story across many other bread brands. In March last year the George Institute for Global Health warned that just one slice of Schwob’s Dark Rye bread contained more than double the amount of salt as a serving of Kettles sea salt crisps (660mg of sodium/100g). More than a year later, Schwob’s website shows no change in the product’s nutritional information.
The same George Institute report highlighted extremely high salt levels in flat breads, naming Coles Tortillas, which contained 920mg of sodium per 100g in 2017 and still do today.
Consumers in the dark
One of the challenges for consumers trying to reduce their dietary salt intake is that sodium is often a hidden and unexpected ingredient.
A study of over 400 people in Lithgow found people tended to underestimate the amount of dietary salt they consumed. Based on dietary recall, people estimated they consumed 6.4g of salt per day on average.
However, 24-hour urine collection revealed the best estimate of daily salt intake was about 9·9 g/day – around twice as much as the World Health Organisation’s recommendation of maximum salt intake of 5g/day.
Consumers may also be left confused by mixed media messages about the potential harms of salt.
For instance, an observational study of over 90,000 people published in the Lancet last month found both low and high sodium intake (below 2g/day or above 5g/day) were associated with an increased risk of cardiovascular disease.
However, experts have criticised that study’s method of measuring salt intake, and aspects of its design, including the potential for reverse causation if people switched to a low-salt diet due to ill health.
Professor Bruce Neal, a Senior Director at The George Institute said: “It remains the case that the totality of the available evidence provides a strong argument for significant harms from excess salt consumption all around the world.”
To help consumers be more aware of their salt intake, the George Institute has produced the FoodSwitch App, which enables users to scan the barcode of supermarket products and quickly identify whether they have low, medium or high sodium content. The app has had 750,000 all-time downloads.
The big retailers
Both Coles and Woolworths are executive members of the Healthy Food Partnership.
Clare Farrand, Senior Project Manager for Salt Reduction at the World Health Organisation Collaborating Centre on Population Salt Reduction told doctorportal:
“Currently Woolworths is leading the way in the retail space in Australia and has committed to improving the nutritional profile of their own brands.”
She added: “There is still a long way to go, but this is a positive first step, which we hope will encourage many more companies to get on board.”
In 2015, Woolworths worked with The George Institute to develop over 150 category targets for sodium, sugar, saturated fat and kilojoules. All products developed under Woolworths Own Brand are required to meet these targets.
A spokeswoman for Coles told doctorportal the retailer intends to work with its suppliers to achieve the final salt-reduction targets, which are due to be released by the Partnership in early 2019.
“Since 2010, the company has annually removed more than 40 tonnes of salt from its Own Brand products,” she added.
[World Report] Crisis in the Chad Basin
Those in the region are contending with displacement, malnutrition, drought, and poor access to health care, 9 years after the Boko Haram insurgency began. Sharmila Devi reports.
[Articles] Armed conflict and child mortality in Africa: a geospatial analysis
Armed conflict substantially and persistently increases infant mortality in Africa, with effect sizes on a scale with malnutrition and several times greater than existing estimates of the mortality burden of conflict. The toll of conflict on children, who are presumably not combatants, underscores the indirect toll of conflict on civilian populations, and the importance of developing interventions to address child health in areas of conflict.
Queensland hospitals to ban sugary drinks and junk food
Queensland has heeded the AMA’s call to ban sugar-sweetened drinks and unhealthy snacks from its public hospitals and health care facilities.
Vending machines and cafes will go junk-free by the end of this year, after the new guidelines are drawn up.
State Health Minister Steven Miles said junk food advertising around children in schools, sports grounds, and public transport hubs will also be phased out under the State-wide ban.
Minister Miles said Queensland’s nutritional standards guidelines are expected to eventually be adopted by other States.
“It’s staggering that one-quarter of Queensland kids are either overweight or obese,” he told the ABC.
“By the end of the year, we’ll have a set of nationally agreed standards for healthier food and drink choices in public health care facilities.
“I want to see these standards phase out sugary drinks and junk food.”
The exact threshold of what will be deemed “unhealthy” is yet to be determined.
The AMA called for health care facilities to provide access to healthy foods, and to remove or replace vending machines containing sugary drinks and other unhealthy foods, in its Position Statement on Nutrition 2018.
Probiotics and prebiotics – is it safe to use them to treat disease?
The link between gut microbes and health is now well established. As a result, researchers have been investigating the effects of probiotics, prebiotics and synbiotics on various diseases. Worryingly, though, they haven’t been reporting on the safety of these treatments – as one would for a drug trial.
A new review of 384 randomised controlled trials, published in Annals of Internal Medicine, found that information on the safety of these supplements is either lacking or not reported.
More than a quarter of the trials (28%) didn’t report any harms data, and safety results weren’t reported in 37% of the studies. Of the studies that did mention harms, 37% used only “generic statements” to describe adverse events, and 16% used “inadequate metrics”, according to the researchers.
So what?
But what’s all the fuss about, you might wonder? Aren’t these all natural products that are available in supermarkets and health food shops? Indeed, the two main families of probiotic bacteria, Lactobacillus and Bifidobacterium, are found in many fermented foods, such as sauerkraut, kimchi and yogurt.
marekuliasz/Shutterstock.com
Prebiotics don’t even contain bacteria, they are merely food on which probiotics feast. They are fibres that can’t be absorbed or broken down by the body, but they nourish friendly bacteria, particularly the Bifidobacteria genus. Bananas, onions, garlic and legumes are natural prebiotic sources.
Synbiotics are foods or supplements that combine probiotics and prebiotics.
Although these products all sound harmless, and may not do any harm to a healthy person, a good clinical trial should always report adverse events (harms). Trials involving these supplements are often in patients who are severely ill or physically vulnerable, such as preterm babies, so the effect of probiotics, prebiotics or synbiotics might be different in these patients.
Several case studies have reported an increased risk of fungaemia – the presence of fungi or yeasts in the blood – in people treated with probiotics. This complication is rare and it tends to happen in people with suppressed immune systems, but it is serious.
Probiotics can have serious adverse effects in other vulnerable groups. For example, a 24-year-old woman, who was administered probiotics before aortic valve replacement surgery, developed sepsis.
In the past few years, probiotic use in hospitals has increased greatly. However, there is growing evidence that the use of probiotics in patients with organ failure, compromised immune systems and those whose intestinal barrier mechanisms are impaired increases the risk of infection.
A trial in the Netherlands, designed to see whether probiotics (administered as Yakult) could reduce the incidence of infectious complications in patients with severe acute pancreatitis, ended up being investigated after 15 patients died unexpectedly.
A few trials involving probiotics have reported on adverse events in vulnerable groups, such as the elderly, and found no serious harms. But these trials tend to have very low participant numbers, reducing the significance of the claims.
It is clear that there is an urgent need for standard safety and administration protocols for probiotics in clinical trials.
Amreen Bashir, Lecturer in Biomedical Science, Aston University
This article was originally published on The Conversation. Read the original article.
Vitamin D not the brain protector some believe it is
Scientists have failed to find solid clinical evidence for vitamin D as a protective neurological agent, according to new research published in Nutritional Neuroscience.
South Australian researchers believe that vitamin D is unlikely to protect individuals from multiple sclerosis, Parkinson’s disease, Alzheimer’s disease or other brain-related disorders.
“Our work counters an emerging belief held in some quarters suggesting that higher levels of vitamin D can impact positively on brain health,” said lead author Krystal Iacopetta, PhD candidate at the University of Adelaide.
“Past studies had found that patients with a neurodegenerative disease tended to have lower levels of vitamin D compared to healthy members of the population.
“This led to the hypothesis that increasing vitamin D levels, either through more UV and sun exposure or by taking vitamin D supplements, could potentially have a positive impact. A widely held community belief is that these supplements could reduce the risk of developing brain-related disorders or limit their progression.
“The results of our in-depth review and an analysis of all the scientific literature, however, indicates that this is not the case and that there is no convincing evidence supporting vitamin D as a protective agent for the brain.”
The research was based on a systematic review of more than 70 pre-clinical and clinical studies, investigating the role of vitamin D across a wide range of neurodegenerative diseases.
Ms Iacopetta believes the idea of vitamin D as a neuro-related protector has gained traction based on observational studies as opposed to evaluation of all the clinical evidence.
“Our analysis of methodologies, sample sizes, and effects on treatment and control groups shows that the link between vitamin D and brain disorders is likely to be associative – as opposed to a directly causal relationship,” she said.
“We could not establish a clear role for a neuroprotective benefit from vitamin D for any of the diseases we investigated.”
The university’s Professor Mark Hutchinson said the outcome of the research was important, as it was based on an extremely comprehensive review and analysis of current data and relevant scientific publications.
“We’ve broken a commonly held belief that vitamin D resulting from sun exposure is good for your brain,” Professor Hutchinson said.
Vitamin D is also commonly known as the sunshine vitamin, but Professor Hutchinson said there may be evidence that sun exposure – or UV light – could impact the brain beneficially, in ways other than that related to levels of vitamin D.
“There are some early studies that suggest that UV exposure could have a positive impact on some neurological disorders such as multiple sclerosis,” he said.
“We have presented critical evidence that UV light may impact molecular processes in the brain in a manner that has absolutely nothing to do with vitamin D.
“We need to complete far more research in this area to fully understand what’s happening. It may be that sensible and safe sun exposure is good for the brain and that there are new and exciting factors at play that we have yet to identify and measure.
“Unfortunately, however, it appears as if vitamin D, although essential for healthy living, is not going to be the miracle ‘sunshine tablet’ solution for brain-disorders that some were actively hoping for.”
Researchers involved in this systematic review are affiliated with the University of Adelaide, the University of South Australia and the ARC Centre of Excellence for Nanoscale BioPhotonics (CNBP).
The research paper can be found at: https://doi.org/10.1080/1028415X.2018.1493807
CHRIS JOHNSON
Is oral health the unspoken determinant?
BY AMA PRESIDENT DR TONY BARTONE
According to the Australian Institute of Health and Welfare’s (AIHW) report Australia’s Health 2012, most people will experience oral health issues at some point in their life. In fact, oral diseases are recurrently among the most frequently reported health problems by Australians.
Considered a disease of affluence up until the late 20th century, poor oral health outcomes have now become an indicator of disadvantage, highlighting a lack of access to preventative services. Insufficient access to, high cost of, or long waiting periods for dental services; and low oral care education, have all been associated with patients not seeking dental care when it is needed. Of course, non-fluoridised water supplies also has a role in explaining the prevalence.
However, more recently, it is the modifiable risk factors like poor nutrition, smoking, substance use, stress, and poor oral hygiene that are considered to have the greatest impacts on periodontal diseases.
Dental conditions frequently rank in the top 10 potentially preventable acute condition hospital admissions for Aboriginal and Torres Strait Islander people and were the third leading cause of all preventable hospitalisations in 2013-14, with 63,000 admissions.
Like most other health conditions, Aboriginal and Torres Strait Islander people have poorer oral health outcomes. While Indigenous people currently have most of the same oral health risk factors as non-Indigenous people, they are less likely to have the same access to preventative measures, leading to marked disparities in oral health between Indigenous people and other Australians.
While the majority of oral health concerns are often considered inconsequential, such as avoiding certain foods, or cosmetic with people embarrassed about their physical appearance, there is a significant body of evidence which suggests that oral health may be the undiscussed determinant of health.
More than two decades ago, population-based studies identified possible links between oral health status and chronic diseases such as cardiovascular disease (CVD), diabetes, respiratory diseases, stroke, and kidney diseases, as well as pre-term low birthweight. And the relationship appears to lie with inflammation.
It is clear more research is needed to determine the exact links (if any), between periodontal disease and chronic disease condition, however, the growing body of evidence links poor oral health to major chronic illnesses.
The Government has made numerous financial commitments to improving access to dental services, however, oral health data will continue to demonstrate that without equitable access to dental services, Australians, and particularly Aboriginal and Torres Strait Islander people, will continue to suffer poorer oral health outcomes, and potentially poorer health outcomes, as a result.
The AMA supports improved Doctor/Dentist collaborations if such partnerships could lead to increased early identification of both chronic disease and oral health conditions, particularly for Aboriginal and Torres Strait Islander peoples, for whom oral health services are less frequently accessed.
Dental Health Week is 6-12 August 2018.
[Comment] Sugar, tobacco, and alcohol taxes to achieve the SDGs
More than a decade after the adoption of the WHO Framework Convention on Tobacco Control, there is compelling evidence that raising tobacco prices substantially through taxation is the single most effective way to reduce tobacco use and save lives.1 Similarly, alcohol taxation is a cost-effective way to reduce alcohol consumption and harm.2 With growing evidence, sugar taxes are another fiscal tool to promote health and nutrition.3 Mexico’s sugar tax reduced sugar-sweetened beverage sales by 5% in the first year, with an almost 10% further reduction in the second year.