Reducing non-communicable diseases among Palestinian populations in Gaza: A participatory comparative and cost-effectiveness modeling assessment.

We sought to assess the effectiveness and cost-effectiveness of potential new public health and healthcare NCD risk reduction efforts among Palestinians in Gaza. We created a microsimulation model using: (i) a cross-sectional household survey of NCD risk factors among 4,576 Palestinian adults aged ≥40 years old in Gaza; (ii) a modified Delphi process among local public health experts to identify potentially feasible new interventions; and (iii) reviews of intervention cost and effectiveness, modified to the Gazan and refugee contexts. The survey revealed 28.6% tobacco smoking, a 40.4% prevalence of hypertension diagnosis (with a 95.6% medication treatment rate), a 25.6% prevalence of diabetes diagnosis (with 95.3% on treatment), a 21.9% prevalence of dyslipidemia (with 79.6% on a statin), and a 9.8% prevalence of asthma or chronic obstructive pulmonary disease (without known treatment). A calibrated model estimated a loss of 9,516 DALYs per 10,000 population over the 10-year policy horizon. The interventions having an incremental cost-effectiveness ratio (ICER) less than three times the GDP per capita of Palestine per DALY averted (<$10,992 per DALY averted)(<$10,992 per DALY averted) included bans on tobacco smoking in indoor and public places [$34 per incremental DALY averted (95% CI: $17, $50)], treatment of asthma using low dose inhaled beclometasone and short-acting beta-agonists [$140 per DALY averted (95% CI: $77, $207)], treatment of breast cancer stages I and II [$730 per DALY averted (95% CI: $372, $1,100)], implementing a mass media campaign for healthier nutrition [$737 per DALY averted (95% CI: $403, $1,100)], treatment of colorectal cancer stages I and II [$7,657 per DALY averted (95% CI: $3,721, $11,639)], and (screening with mammography [$17,054 per DALY averted (95% CI: $8,693, $25,359)]). Despite high levels of NCD risk factors among Palestinians in Gaza, we estimated that several interventions would be expected to reduce the loss of DALYs within common cost-effectiveness thresholds.

Low-quality protein modulates inflammatory markers and the response to lipopolysaccharide insult: the case of lysine.

The relationship between non-communicable diseases and eating behaviour has long been attributed to a surplus of food and energy. However, the increase in the prevalence of non-communicable disease and their underlying low-grade inflammatory milieu among people of low socio-economic status has highlighted the existence of a confounding factor. In this work, we aim to study the effect of lysine deficiency on some inflammatory markers in the absence or presence of an inflammatory insult (lipopolysaccharide (LPS)). For this purpose, thirty-two 5-week-old male Sprague Dawley rats were randomly distributed into four groups: (1) control diet, (2) control diet+LPS, (3) lysine-deficient diet and (4) lysine-deficient diet + LPS. Groups were only allowed their experimental diets for 4 weeks, during which LPS (50 µg/kg) or saline injections were administered intraperitoneally three times per week. The study showed that lysine deficiency blunted growth and body compartments development, decreased albumin production and elevated liver C-reactive protein (CRP) expression, independently of IL-6 and IL-1ß, the main precursors of CRP. Also, the insufficient levels of lysine in the diet increased hyperactivity and triggered an anxiety-like behaviour, exacerbated with LPS. This work presents evidence that various physiological changes are associated with the absence of a sufficient amount of lysine in the diet and can potentially increase the risk factor for diseases. Thus, the increment in non-communicable disease among the low socio-economic status populations, who heavily rely on cereals as a main source of protein, can be, at least partially, blamed on low lysine availability in diets.

The hypertension cascade of care in the midst of conflict: the case of the Gaza Strip.

Although hypertension constitutes a substantial burden in conflict-affected areas, little is known about its prevalence, control, and management in Gaza. This study aims to estimate the prevalence and correlates of hypertension, its diagnosis and control among adults in Gaza. We conducted a representative, cross-sectional, anonymous, household survey of 4576 persons older than 40 years in Gaza in mid-2020. Data were collected through face-to-face interviews, anthropometric, and blood pressure measurements. Hypertension was defined in anyone with an average systolic blood pressure ≥140 mmHg or average diastolic blood pressure ≥90 mmHg from two consecutive readings or a hypertension diagnosis. The mean age of participants was 56.9 ± 10.5 years, 54.0% were female and 68.5% were Palestinian refugees. The prevalence of hypertension was 56.5%, of whom 71.5% had been diagnosed. Hypertension was significantly higher among older participants, refugees, ex-smokers, those who were overweight or obese, and had other co-morbidities including mental illnesses. Two-thirds (68.3%) of those with hypertension were on treatment with one in three (35.6%) having their hypertension controlled. Having controlled hypertension was significantly higher in females, those receiving all medications for high blood pressure and those who never or rarely added salt to food. Investing in comprehensive but cost-effective initiatives that strengthen the prevention, early detection and timely treatment of hypertension in conflict settings is critical. It is essential to better understand the underlying barriers behind the lack of control and develop multi-sectoral programs to address these barriers.

The effect of aspartame and sucralose intake on body weight measures and blood metabolites: role of their form (solid and/or liquid) of ingestion.

The ingestion of non-caloric sweeteners (NCS) from food and/or drink was intended to reduce caloric intake without compromising palatability. However, the inconclusive relation between NCS and body weight may partially relate to their form of ingestion (solid or liquid). Thus, two paralleled experiments (aspartame and sucralose) were conducted. In each, Sprague Dawley rats (7-week-old male) were randomly divided into four groups. In Expt 1, aspartame (0·05 %) was added to the diet (AD) or drinking water (AW) or both diet and water (ADW), and a control group (C) was given a non-sweetened diet with plain water. In Expt 2, sucralose (0·016 %) was similarly provided in the diet (SD) or drinking water (SW) or both diet and water (SDW), with a control group (C). All rats had free access to food and water for 7 weeks. Energy intake, body weight and body composition were monitored and blood metabolites were determined. Results showed that aspartame ingestion significantly increased body weight and fat mass mainly due to an increase in energy efficiency. The effect was related to the amount rather than the form of ingestion. Additionally, aspartame ingestion was associated with glucose intolerance. Sucralose ingestion had a similar impact to that of aspartame though to a lesser extent. In conclusion, 7-week ingestion of aspartame and sucralose had adverse effects on body measures that were not related to the form of ingestion.

Phosphorus Supplementation Mitigates Perivascular Adipose Inflammation-Induced Cardiovascular Consequences in Early Metabolic Impairment.

Background The complexity of the interaction between metabolic dysfunction and cardiovascular complications has long been recognized to extend beyond simple perturbations of blood glucose levels. Yet, structured interventions targeting the root pathologies are not forthcoming. Growing evidence implicates the inflammatory changes occurring in perivascular adipose tissue (PVAT) as early instigators of cardiovascular deterioration. Methods and Results We used a nonobese prediabetic rat model with localized PVAT inflammation induced by hypercaloric diet feeding, which dilutes inorganic phosphorus (Pi) to energy ratio by 50%, to investigate whether Pi supplementation ameliorates the early metabolic impairment. A 12-week Pi supplementation at concentrations equivalent to and twice as much as that in the control diet was performed. The localized PVAT inflammation was reversed in a dose-dependent manner. The increased expression of UCP1 (uncoupling protein1), HIF-1α (hypoxia inducible factor-1α), and IL-1ß (interleukin-1ß), representing the hallmark of PVAT inflammation in this rat model, were reversed, with normalization of PVAT macrophage polarization. Pi supplementation restored the metabolic efficiency consistent with its putative role as an UCP1 inhibitor. Alongside, parasympathetic autonomic and cerebrovascular dysfunction function observed in the prediabetic model was reversed, together with the mitigation of multiple molecular and histological cardiovascular damage markers. Significantly, a Pi-deficient control diet neither induced PVAT inflammation nor cardiovascular dysfunction, whereas Pi reinstatement in the diet after a 10-week exposure to a hypercaloric low-Pi diet ameliorated the dysfunction. Conclusions Our present results propose Pi supplementation as a simple intervention to reverse PVAT inflammation and its early cardiovascular consequences, possibly through the interference with hypercaloric-induced increase in UCP1 expression/activity.

The Effect of the Temperature of Plain or Sweetened Water on Body Composition in Rats.

INTRODUCTION: Humans are known to adapt to external temperature variations by altering energy intake, expenditure, and body fat storage for insulation [1, 2]. However, it is not clear whether the temperature of ingested water would induce such effects. Similarly, the involvement of the temperature of the ingested beverage has not been addressed in terms of body weight changes [3]. OBJECTIVES: This study was to investigate the effect of the ingestion of plain or sweetened water with varied temperatures on growth measures of rats. METHODS: Approval was obtained from the Institutional Animal Care and Use Committee of the American University of Beirut. After a 1-week adaptation period, 5- to 6-week-old male Sprague-Dawley rats were randomly divided into their respective experimental groups, housed individually (22 ± 1°C, reverse light cycle 12:12 h dark/light, light off at 10:00 a.m.) with free access to food and beverage for 8 weeks. Experiment 1 (Plain Water): Two groups of rats (n = 9) consumed room-temperature [∼22°C] (NW) or cold [∼5°C] (CW) water. Experiment 2 (Sweetened Water): Four groups of rats were offered sweetened water for 12 h, followed by plain water; (1) 10% sucrose + cold temperature (CS, n = 7), (2) 10% sucrose + room temperature (NS, n = 8), (3) 0.05% acesulfame K + cold temperature (CA, n = 7), and 4) 0.05% acesulfame K + room temperature (NA, n = 8). Food and beverage intake, body weight, and body composition were monitored using NMR minispec (LF110 Body Composition Analyzer, Bruker, USA) and energy expenditure was calculated based on the equation developed by Ravussin et al. [4]. Significance was set at a p value <0.05. RESULTS: Experiment 1: Body weight changes were similar between groups (Fig. 1-Exp 1a). In the CW group, lean body mass (%) was significantly higher, while body fat (%) was lower than the NW (Fig. 1-Exp 1b, c). These changes may relate to the calculated total energy expenditure [NW: 66.73 ± 4.49 kcal/day and CW: 73.75 ± 3.92 kcal/day) (p value = 0.003) since energy intake (NW: 89.97 ± 7.63 kcal/day vs. CW: 93.29 ± 6.26 kcal/day, p value = 0.329) was similar between groups. Experiment 2: Body weight of the CA group was higher than that of the other groups (Fig. 1-Exp 2a). Lean body mass (%) of the sucrose-sweetened water groups (Fig. 1-Exp 2b, c) was significantly higher, while body fat (%) was lower than that of the non-caloric sweetened water groups; these were not affected by the temperature of the beverage. Those variations are mostly explained by the differences in energy expenditure (p value temperature × sweetener = 0.015), as energy intake was not significantly different between groups. CONCLUSION: Cold plain water decreased body fat and increased lean body mass with no effect on total body weight. Sucrose-sweetened water had a better impact on body composition irrespective of the temperature of the beverage. The beneficial effects are mainly due to increased energy expenditure rather than variations in energy intake. Thus, the energy cost of warming the water seems to have been derived from an increase in fat oxidation.

Concomitant lysine and phosphorus addition to a wheat gluten protein diet highly amplified growth measures of rats.

OBJECTIVE: In humans, the effects of lysine-fortified wheat on growth measures was much lower than that of animal experimentations that used phosphorus-containing mineral mix. It is known that wheat contains a limited amount of available phosphorus, which is believed to support growth. The aim of this study was to determine the involvement of phosphorus in growth measures of rats maintained on a lysine-supplemented wheat gluten diet. METHODS: Forty male Sprague-Dawley (6 wk old) rats were randomly divided into four equal groups and fed wheat gluten protein (10%)-based diets with added lysine (0.6%), phosphorus (0.3%), or both (0.6% lysine and 0.3% phosphorus), ad libitum for 9 wk. Rats were monitored for changes in food intake, body weight, body and liver compositions, plasma urea nitrogen, and albumin. RESULTS: The addition of lysine or phosphorus to wheat gluten-based diets increased energy intake modestly (∼15%), whereas their combination caused a higher increase (∼45%). Similarly, the magnitude of improvement in weight gain and energy efficiency by the addition of lysine or phosphorus (∼1g/d and 2.7g/MJ, respectively) was much lower than that of the combination (∼4g/d and 8.7g/MJ). In the phosphorus-containing groups, plasma urea nitrogen was significantly reduced and this was associated with higher body protein (%) and hepatic fat (%); whereas plasma albumin was significantly increased in the lysine-containing groups. CONCLUSION: When using gluten protein, concomitant lysine and phosphorus availability is required to support growth measures, although phosphorus seems to have an independent effect on protein metabolism. Thus, human interventions should consider the improvement of the amino acid profile and phosphorus availability.