Association of comorbidity between Opisthorchis viverrini infection and diabetes mellitus in the development of cholangiocarcinoma among a high-risk population, northeastern Thailand.

BACKGROUND: Cholangiocarcinoma (CCA) is a category of lethal hepatobiliary malignancies. Previous studies have found that Opisthorchis viverrini infection and diabetes mellitus (DM) are closely correlated with CCA. However, few studies have discussed the association of CCA with a combination of both O. viverrini infection and DM. This study aimed to assess the correlation of CCA with various combinations of O. viverrini infection and DM among a high-risk population in northeastern Thailand. METHODOLOGY: This study included participants from 20 provinces in northeastern Thailand who had been screened for CCA in the Cholangiocarcinoma Screening and Care Program (CASCAP) between 2013 and 2019. Histories of O. viverrini infection and DM diagnosis were obtained using a health questionnaire. CCA screening used ultrasonography with a definitive diagnosis based on histopathology. Multilevel mixed-effects logistic regression was performed to quantify the association, which is presented as adjusted odds ratios (aOR) and their 95% confidence intervals (CI). PRINCIPAL FINDINGS: Overall, 263,776 participants were included, of whom 32.4% were infected with O. viverrini, 8.2% were diagnosed with DM, and 2.9% had a history of both O. viverrini infection and DM. The overall rate of CCA was 0.36%. Of those infected with O. viverrini, 0.47% had CCA; among those with DM, 0.59% had CCA and among those infected with O. viverrini and had DM, 0.73% had CCA. Compared with participants who were not infected with O. viverrini and were non-DM, the aOR for those infected with O. viverrini and with DM was 2.36 (95% CI: 1.74-3.21; p-value <0.001). CONCLUSIONS: The combination of O. viverrini infection and DM was highly associated with CCA, and these two conditions had a combined effect on this association that was greater than that of either alone. These findings suggest that CCA screening should have a strong focus on people with a combination of O. viverrini infection and DM.

Improved control of non-communicable diseases (NCDs) requires an additional advanced concept for public health - a perspective from a middle-income country.

A major consequence of all elements of the 'epidemiological transition' is the rapid emergence of non-communicable diseases (NCDs) in low- and middle-income countries. In contrast to the outcomes of the 'Alma Ata Conference for Primary Health Care', it has not yet been possible to introduce an equally powerful health policy for the prevention and control of NCDs. Major strategies so far are to advise individuals not to smoke and drink alcohol in excess. Additionally, 'healthy' nutrition and increased physical activity are also advocated. Policy for preventing and working against NCDs is now part of the Sustainable Development Goals, specifically target 3.4. So far, attempts to soften the influence of NCDs on the health of the people in low- and middle-income countries have been unsuccessful. It is argued here that additional concepts on how public health could operate against NCDs are needed.  Major risk factors for NCDs interfere with and alter complex steps within the human metabolism.  This paper explores how human metabolism works by assessing advances in molecular biology and research in genetics, epigenetics and gerontology. Recent developments in these scientific disciplines shed light on the complexity of how human health is maintained and diseases are invoked. Public health bodies should be aware, interested and possibly contribute to the aforementioned areas of interest, as far as NCDs are concerned, and translate major developments in a way, that could be useful in improving population health.

Public health research needs for molecular epidemiology and to emphasize homeostasis - could the omnipotent endopeptidase inhibitor α-2-macroglobulin be a meaningful biomarker?

Public health authorities in low- and middle-income countries face dramatic challenges in handling rapidly increasing non-communicable diseases (NCDs), due to the epidemiological- and particularly nutritional transition. Among major reasons for the development of NCDs are smoking and alcohol, but overnutrition and obesity are also major threats to population health. Obesity is related to diabetes and cancer, but also has a genetic background. It is difficult to recommend a healthy nutrition. This is because of conflicting nutritional conceptions, and given the complexity of human metabolism understanding this topic can be difficult for the laymen.  Public health measures advocating physical activity and refraining from high intake of energy, sugar and soft drinks need to be enhanced by supporting the 'intrinsic motivation' to preserve a good health. The mission of public health should be to increase awareness about the complexity of human metabolism, and the involvement of genetic and epigenetics in health and diseases. To maintain homeostasis, means to keep an optimal relationship between catabolism and synthesis, seems to be of particular interest. Preconditions for this is, that public health institutions within the administration- and academic sector follow up developments in life science and molecular biology and conduct population-based research making use of molecular epidemiology, especially those related to key metabolic steps and maintenance of 'homeostasis', in balancing catabolism and anabolism. A prospective biomarker for this situation might be α-2-macroglobulin.

Dietary patterns and their association with the components of metabolic syndrome: A cross-sectional study of adults from northeast Thailand.

Background: Nutritional transition influences a shift in eating behaviour that is associated with a rise in the prevalence of non-communicable diseases (NCDs). Metabolic syndrome (MetS) comprises a set of NCD risk factors. This study aimed to investigate dietary patterns and to determine the relationship between dietary patterns and MetS and its components. Methods: A cross-sectional study was conducted among 468 healthy adults aged 35-60 years who were residents of a semi-urban district of one of the central provinces in the northeast of Thailand. A factor analysis identified dietary patterns based on the consumption of 21 food groups, which were assessed by using a semi-quantitative food frequency questionnaire. MetS was identified by using the harmonized criteria that were stipulated by six leading international organisations. The association between dietary patterns and MetS and its components were evaluated by multiple logistic regressions. The confounding factors adjusted in the model were age, sex, smoking status, physical activity, and medication intake. Results: Two dietary patterns were identified: a traditional pattern characterised by high intakes of sticky rice and animal source foods; a mixed pattern included high intakes of white rice and a variety of food groups. The two dietary patterns did not show any association with MetS. Participants in the highest tertile of the traditional pattern was significantly related to high triglycerides (adjusted OR = 1.74, 95% CI: 1.10-2.88), in comparison to those from the lowest tertile, whereas participants in the highest tertile of the mixed pattern was inversely associated with abdominal obesity (adjusted OR= 0.49, 95% CI: 0.30-0.81) than those in the lowest tertile. Conclusions: Adherence to a traditional dietary pattern among the northeast Thai adults, in the context of nutrition transition, was associated with high triglyceride levels while the mixed dietary pattern was inversely related to abdominal obesity.