Recent research from Leicester University and the University of Cambridge’s Medical Research Council Toxicology unit in the UK, the Steno Diabetes Centre in Denmark, and the Massachusetts Institute of Technology in Cambridge, Massachusetts, suggests that having a poor diet during pregnancy will risk the chance of offspring developing diabetes in later life.

The research focused on the way diet in early life affects both the composition and behaviour of fat tissues.  While this laboratory study was conducted with rats, the research team cautiously suggests a generalisability to the human population, and identifies a mechanism through which poor early nutrition may impact the development and location of fat tissue. High levels of a newly identified molecule causes fat to be stored inappropriately in the muscle and liver, and is linked to both insulin resistance and high levels of diabetes.

The contemporary diet leads to storage of excess calories in fat cells, and when the cells become over-burdened they store calories in and around organs such as the liver, which can cause insulin resistance and render people more susceptible to type 2 diabetes in later life. This study lends even more credence to the early origins of health hypothesis that C3 has been exploring recently (click here >>).

Sources: NHS Choices, 9 January 2012; The Telegraph, 6 January 2012; Ferland-McCollough et al., ‘Programming of adipose tissue miR-483-3p and GDF-3 expression by maternal diet in type 2 diabetes’, Cell Death and Differentiation, 6 January 2012.

Whether the WHO definitions or National Working Group on Obesity in China measures are used to define overweight and obesity, around 20 per cent of urban residents were overweight or obese, versus 3-7 per cent in the rural areas. The Yi are a minority national population in this area and are believed to be at higher risk.

Dramatic development of the Chinese economy during the past decades has wrought major lifestyle changes in the provinces that have led to an alarming increase in chronic disease risk factors such as  hypertension, and a major spike in diabetes rates. More sedentary lifestyles have become common and the epidemic status of obesity in this region coincides with both economic growth and rise in family income levels.  The agrarian lifestyle has given way to higher levels of education and higher income in urban areas but has not yet generated greater health. Significant among the research findings is that 60 per cent of the men participating in the study were smokers.

Researchers believe that the overall differences between the rural and urban groups may be explained in part by lifestyle and by socio-economic differences among the groups. They further add that a greater emphasis by the state on education and prevention strategies in urban settings will help to stem the tide of preventable disease that inevitably follows rising obesity levels.

Sources: Y Gao et al., ‘Prevalence of overweight and obesity among Chinese Yi nationality: a cross-sectional study’, BioMed Central Public Health, 13 December 2011; Stone Health News, 13 December 2011.

In a review the authors hail as the most comprehensive to date, evidence is presented which confirms that cancer is certainly not completely driven by either heredity or fate but rather can be influenced by our environment and behaviours.  Cancer typically has multiple causes and thus one cannot identify whether an individual’s cancer is caused by a particular disease vector, but understanding this can assist in predicting the number of potentially preventable cancers.

As the study analysed gender specific causes of cancers, the best recommendations for women are to avoid smoking, overweight and excess alcohol consumption; for men the top line recommends stopping smoking, increase consumption of fruit and vegetables and reduce alcohol intake.

Lead author is Professor Max Parkin, epidemiologist at the Wolfson Institute of Preventative Medicine, Queen Mary University, London.

An important fact to note here is that the probability of death before age 70 has been halved during the past 40 years and that during the next few decades it could be cut by half again with improvements in treatment and focusing attention on the avoidable causes of disease.

Sources: BBC Health, ‘Over 40% of Cancers Due to Lifestyle, Says Report‘, 7 December 2011; D.M. Parkin et al., ‘The fraction of cancer attributable to lifestyle and environment factors in the UK in 2010′, British Journal of Cancer 105:S2, 6 December 2011; NHS Choices, ‘Lifestyle changes could slash cancer rates, 7 December 2011; Cancer Research UK: Cigarettes, diet, alcohol and obesity behind more than 100,000 cancers (press release), 7 December 2011.

Several risk factors have been identified across populations that  contribute to CVD – smoking, blood fats, diabetes, sub-optimal nutrition and high blood pressure – but addressing these factors has had less impact in South Asian populations and researchers speculate that this group may be plagued by some additional, unidentified factors. Professor John Danesh, University of Cambridge professor of epidemiology and medicine and director  of the Department of Public Health and Primary Care, suspects that a particular combination of risk factors, including biochemical, genetic and lifestyle components impact CVD risk within this group.

Two large population studies have been developed to research this conundrum, the first focusing on Pakistan, with a population of 187 million.  PROMIS, funded through the US NIH, the Wellcome Trust and the British Heart Foundation, has already provided significant interim findings, recently published in Nature Genetics, which include identification of key genes implicated in coronary disease and type 2 diabetes.  The second study, BRAVE,  focuses on Bangladesh, which has the highest rates of CVD in the world – as well as highest rates of urbanisation and population density – but is the least studied. PROMIS seeks to explain the particular factors that  make this population more vulnerable to CVD.  The BRAVE study seeks to identify modifiable risk factors in this region – consumption of ghee and indigenous tobacco, including ‘naswar’, according to the head of  the Karachi-based Centre for Non-Communicable Diseases, Dr Saleheen. This study in particular is expected to yield novel findings, especially since that the study recruits patients with cardiac issues or diabetes.

Sources: Insight Radio, Heart Matters – South Asians and Heart Disease, 30 November 2011; University of Cambridge Research Features, ‘High-risk hearts:  a South Asian epidemic’.

The tours take place every other Friday, and are open to anyone, but it is suggested that they are particularly useful for those who need to lose weight, who are at high risk or with a family history of heart disease, or who have diabetes.

Sources: Lewisham Life, November 2011 and Lewisham NHS Trust website.

In a similar vein, the European Journal of Public Health recently published a study showing the way package labelling can assist individuals in making healthy food purchases and consumption choices.  Although there has been prior research detailing strategies to assist consumers wade through nutritional labels in the food marketplace in attempt  to  making healthier food product selection, use of front-of-package nutrition labelling is a relatively new approach to providing information about food, and is now widely used throughout Europe.

This study assumes, based on earlier evidence, that nutritional labelling can be a helpful consumer tool, and looks into whether having multiple labelling formats creates an impediment to understanding nutritional composition.  It further looks to identify which labelling formats are the most easily understood.

Qualitative interviews were conducted and interviewers found a great deal of confusion among interviewees, who found it ‘challenging’ to compare among labels which lacked common elements, such as  label formats or text type. The comparisons also took time and effort that would be a deterrent in real-world situations.

The study results demonstrate that in shopping situations, consumers may not be inclined to use data which is difficult to compare, and that a consistent label format would make it easier for consumers to compare food products without misinterpretation.

Sources: Draper, ‘ Front of package product labelling: are multiple formats a problem for consumers?’, European Journal of Public Health, 14 September 2011; Oxford Journals release, 2 December 2011.

The lifting of the restrictions on imports in a country with one of the highest rates of obesity in the world (32 per cent of men and 63 per cent  of women are estimated to be obese) was certainly not welcomed by health campaigners. As Samoa’s director general of health, Palanitina Tupuimatagi Toelupe, put it: ‘These are the contradictions we have to face—where health is compromised for the sake of trade and development.’ Another Pacific Island, Tonga, also had to water down proposals to restrict imports on the back of its WTO membership, which confers increased trade and lowered import costs.

The balance between health and trade is a fine one: but is it not time to prioritise health?

Sources: Business Week, 22 November 2011; Taking up the Challenge of NCDs in the Commonwealth: 17 Good-practice Case Studies (C3 and Commonwealth Secretariat), click here >>

• In France, the Foundation is providing funding for 220 refrigeration units to French Red Cross locations across the country. This will allow for better distribution of fresh foods, including fruits, vegetables, dairy and meat, which are  Over the next three years, the units are expected to help distribute up to 50 million more meals to those in need over the next three years. A pilot programme will also be funded to implement a nutrition education workshop in 30 French Red Cross locations, to teach those attending how to cook cheap, healthy meals.
• In Germany, the Foundation is holding 800 healthy lifestyle classes 20,000 primary-school children over five years, covering nutrition, exercise, relaxation, life skills and saying no to tobacco and alcohol. Parents are also involved, and support their children with activities to do at home.
• In Italy, where nearly a quarter of children struggle with their weight, with its partners the Foundation is launching healthy living classes (including sport activities and games, as well as healthy eating workshops) are launching in 10 Italian cities to benefit at-risk communities – and the funding will also help to improve sports facilities and playgrounds. It will reach 32,000 children in three years.
• Finally, in Spain, the Alicia Foundation and Kraft Foundation will fund health education programmes and cooking workshops in schools. Children will track their food intake and physical activity, and they will analyse the data and come up with solutions to improve lifestyles. The 10 best proposals will be published online for educators across Spain to use.

Source: CSR Wire, 29 November 2011.

Another major resource constraint will arise from the lack of water available for farming. Many nations, such as South Africa, are already ‘water stressed’, and the UN FAO report, which focuses on agriculture and food security, suggests that within 40 years many areas in the world will not have access to water for farming, which forms the backbone of the economies in developing nations, where 75 per cent of the population is poor, rural and dependent on agriculture for both food and income.

Development of a sustainable international  ‘ecosystem framework’, which will include land and water policy and focus on agricultural production, as suggested in the recent FAO issue paper, will help to develop a more holistic approach to nutrition for resource poor nations.

Sources: ‘Energy smart food for people and climate’ issue paper, UN FAO, November 2011 (click here >>); IRIN Global, humanitarian news and analysis, 28 November 2011.

There are now some signs that environmentalists and health professionals are beginning to take note of the synergies available in tackling climate change and human health. The Climate and Health Council (here >>) is a network of health professionals interested in this area (around 5,000 of whom, from over 70 countries, have signed a Pledge to protect health and call for a framework to control carbon emissions). The first ever Global Climate and Health Summit Summit (co-organised by the World Federation of Public Health Associations, the Climate and Health Council, Health Care Without Harm and the Nelson R. Mandela School of Medicine at the University of KwaZulu Natal, in partnership with the World Health Organization, the World Medical Association and the International Council of Nurses, among others) is being held on 4 December to coincide with COP17 (more information will be available here >>).

For tweets on health from COP17, follow Climate Health Connect on Twitter (here >>).

The voice of health professionals has been largely silent in the discussions to date, despite the substantial role that the sector can play in reducing carbon emissions – not only by saving money by reducing the environmental footprint of health facilities, but by promoting the clear win–wins for human health when working to mitigate climate change, with many of these potential gains relating to the major risk factors for NCDs:

• Transport is a major contributor to CO₂ emissions. Reducing the number of miles driven – substituting walking and cycling – is an obvious way in which human health could benefit from what appears to be a primarily environmental intervention. This will reduce air pollution (which contributes to the risk of CVD, COPD and lung cancer) and traffic accidents – each of which cause over 1 million deaths a year: mortality in cities with high levels of pollution exceeds that of relatively cleaner cities by 15–20%. And replacing car use with walking and cycling will also work to reduce levels of overweight and obesity.
• Diet also impacts both on our health and the environment. Meat and dairy production currently accounts for about a fifth of greenhouse gas emissions worldwide – and consumption may double by 2050 if current trends continue. Diets that are high in red meat are also unhealthy – consumption of red meat has been linked to many cancers (including bowel and breast cancer), and meat is high in saturated fats, which can contribute to other NCDs such as heart disease.
• Indoor air pollution, largely caused by open fires or traditional stoves, is not only an environmental hazard: it is responsible for around 2 million deaths annually, mostly in developing countries. It increases the risk of acute lower respiratory infections among young children, and is a major risk factor for COPD and lung cancer in adults, especially women. Finding less environmentally damaging options could also save millions of lives.

COP17 represents a huge opportunity that must not be squandered. ‘What is good for the planet is good for health’ is a message that has the potential to be a powerful political lever for policy-makers, bringing home the real impact that climate change will have on many billions of people.