The Association of Total Meat Intake with Cardio-Metabolic Disease Risk Factors and Measures of Sub-Clinical Atherosclerosis in an Urbanising Community of Southern India: A Cross-Sectional Analysis for the APCAPS Cohort.

AIM: Meat is commonly consumed in India; however, in comparison to Western settings, it is eaten in relatively lower quantities and with minimal processing. The association between meat intake and cardio-metabolic diseases (CMDs) and their risk factors in India is currently uncertain. We examined whether meat intake is associated with risk factors for CMDs and the measures of subclinical atherosclerosis in urbanising villages in southern India. METHODS: We conducted a cross-sectional analysis of 6012 adults (52.3% male) participating in the Andhra Pradesh Children and Parents' Study (APCAPS), which is a large prospective, intergenerational cohort study in Southern India that began with the long-term follow-up of the Hyderabad Nutrition Trial (1987-1990). We used cross-sectional data from the third wave of data collection conducted in 2010-2012, where total meat intake was assessed using 100-item, semi-quantitative validated food frequency questionnaires (FFQ). The FFQs were validated using multiple weighed 24 h dietary recalls. The main predictor, 'total meat intake', was calculated as the sum of chicken, red meat, and fish consumption. The risk factors for CMDs [systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), waist circumference (WC), fasting glucose, total cholesterol, homeostasis model assessment insulin resistance (HOMA-IR), total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, and C-reactive protein] and measures of subclinical atherosclerosis [Carotid Intima-Media Thickness, Pulse Wave Velocity, and Augmentation Index] were assessed using standardised clinical procedures. Stratified by gender, the association of meat intake with the risk factors of CMDs and measures of subclinical atherosclerosis was examined using linear multilevel models with random intercept at the household level. RESULTS: The mean (SD) age of the male (n = 3128) and female participants (n = 2828) was 34.09 years (15.55) and 34.27 years (12.73), respectively. The median (IQR) intake of meat was 17.79 g/day (8.90, 30.26) in males and 8.90 g/day (4.15, 18.82) in females. In males, a 10 g increase in total meat intake/1000 Kcal/day was positively associated with DBP, BMI, WC, total cholesterol, LDL-C, and triglycerides, whereas in females, a 10 g increase in total meat intake/1000 Kcal/day was positively associated with SBP, DBP, fasting glucose, HOMA-IR, total cholesterol, LDL-C, and triglycerides. There was no relationship between meat consumption and measures of subclinical atherosclerosis. CONCLUSIONS: Meat intake had a linear positive association with CMD risk factors among the relatively younger Indian population who were consuming meat at lower levels compared to their European counterparts.

[Body image dissatisfaction and low adherence to the Western dietary standard among schoolchildren: a cross-sectional study]. / Insatisfação com a imagem corporal e baixa aderência ao padrão alimentar ocidental em escolares: um estudo transversal.

This study aimed to identify dietary patterns and to evaluate the association between body image perception and these patterns among schoolchildren. A cross-sectional study was conducted on 385 schoolchildren (both sexes, 10-17 years old) from four public schools in Salvador, Brazil. Two non-consecutive 24-hour dietary recalls were applied, and the dietary pattern was determined by Exploratory Factor Analysis after adjustment of dietary data using the Multiple Source Method. To evaluate body image perception, the Brazilian body shape silhouette was used. The associations between body image perception and dietary patterns using the polytomous logistic regression model adjusted for covariables was assessed. Three dietary patterns were obtained: "Western standard," unhealthy, "healthy pattern" and "typical dishes/ junk food." After adjustment, adolescents who wished for a slimmer silhouette (2.48 [95%CI: 1.04-6.11], 3.49 [95%CI: 1.35-9.05] and 2.87 [95%CI: 1.13-7.26]) were more likely to adhere to the quintiles with the lowest consumption of the Western standard, compared to those satisfied with their body image. No associations were identified in the other two dietary patterns. Adolescents dissatisfied with their bodies tend to adhere less to unhealthy dietary patterns.

Este estudo objetivou identificar padrões alimentares e avaliar a associação entre percepção da imagem corporal e esses padrões em escolares. Um estudo transversal foi conduzido em 385 escolares (ambos os sexos, 10-17 anos de idade) de 4 escolas públicas de Salvador, Brasil. Dois recordatórios alimentares de 24h não consecutivos foram aplicados e o padrão alimentar foi determinado por Análise Fatorial Exploratória, após ajuste dos dados dietéticos pelo Multiple Source Method. Para avaliar percepção da imagem corporal, nós usamos uma escala brasileira de silhuetas. Avaliamos as associações entre percepção da imagem corporal e padrões alimentares usando o modelo de regressão logística politômica ajustado para covariáveis. Três padrões alimentares foram obtidos: "padrão ocidental", "padrão saudável" e "comidas típicas/junk food". Após ajuste, adolescentes que desejavam uma silhueta menor (2,48 [IC95%: 1,04-6,11], 3,49 [IC95%: 1,35-9,05] e 2,87 [IC95%: 1,13-7,26]) tinham mais chances de aderir aos quintis de menor consumo do padrão ocidental, comparados àqueles satisfeitos com sua imagem corporal. Nenhuma associação foi identificada nos outros dois padrões alimentares. Adolescentes insatisfeitos com seus corpos tendem a aderir menos a padrões alimentares não saudáveis.

Insatisfação com a imagem corporal e baixa aderência ao padrão alimentar ocidental em escolares: um estudo transversal / Body image dissatisfaction and low adherence to the Western dietary standard among schoolchildren: a cross-sectional study

Resumo Este estudo objetivou identificar padrões alimentares e avaliar a associação entre percepção da imagem corporal e esses padrões em escolares. Um estudo transversal foi conduzido em 385 escolares (ambos os sexos, 10-17 anos de idade) de 4 escolas públicas de Salvador, Brasil. Dois recordatórios alimentares de 24h não consecutivos foram aplicados e o padrão alimentar foi determinado por Análise Fatorial Exploratória, após ajuste dos dados dietéticos pelo Multiple Source Method. Para avaliar percepção da imagem corporal, nós usamos uma escala brasileira de silhuetas. Avaliamos as associações entre percepção da imagem corporal e padrões alimentares usando o modelo de regressão logística politômica ajustado para covariáveis. Três padrões alimentares foram obtidos: "padrão ocidental", "padrão saudável" e "comidas típicas/junk food". Após ajuste, adolescentes que desejavam uma silhueta menor (2,48 [IC95%: 1,04-6,11], 3,49 [IC95%: 1,35-9,05] e 2,87 [IC95%: 1,13-7,26]) tinham mais chances de aderir aos quintis de menor consumo do padrão ocidental, comparados àqueles satisfeitos com sua imagem corporal. Nenhuma associação foi identificada nos outros dois padrões alimentares. Adolescentes insatisfeitos com seus corpos tendem a aderir menos a padrões alimentares não saudáveis.

Abstract This study aimed to identify dietary patterns and to evaluate the association between body image perception and these patterns among schoolchildren. A cross-sectional study was conducted on 385 schoolchildren (both sexes, 10-17 years old) from four public schools in Salvador, Brazil. Two non-consecutive 24-hour dietary recalls were applied, and the dietary pattern was determined by Exploratory Factor Analysis after adjustment of dietary data using the Multiple Source Method. To evaluate body image perception, the Brazilian body shape silhouette was used. The associations between body image perception and dietary patterns using the polytomous logistic regression model adjusted for covariables was assessed. Three dietary patterns were obtained: "Western standard," unhealthy, "healthy pattern" and "typical dishes/ junk food." After adjustment, adolescents who wished for a slimmer silhouette (2.48 [95%CI: 1.04-6.11], 3.49 [95%CI: 1.35-9.05] and 2.87 [95%CI: 1.13-7.26]) were more likely to adhere to the quintiles with the lowest consumption of the Western standard, compared to those satisfied with their body image. No associations were identified in the other two dietary patterns. Adolescents dissatisfied with their bodies tend to adhere less to unhealthy dietary patterns.

Burden, determinants, consequences and care of multimorbidity in rural and urbanising Telangana, India: protocol for a mixed-methods study within the APCAPS cohort.

INTRODUCTION: The epidemiological and demographic transitions are leading to a rising burden of multimorbidity (co-occurrence of two or more chronic conditions) worldwide. Evidence on the burden, determinants, consequences and care of multimorbidity in rural and urbanising India is limited, partly due to a lack of longitudinal and objectively measured data on chronic health conditions. We will conduct a mixed-methods study nested in the prospective Andhra Pradesh Children and Parents' Study (APCAPS) cohort to develop a data resource for understanding the epidemiology of multimorbidity in rural and urbanising India and developing interventions to improve the prevention and care of multimorbidity. METHODS AND ANALYSIS: We aim to recruit 2100 APCAPS cohort members aged 45+ who have clinical and lifestyle data collected during a previous cohort follow-up (2010-2012). We will screen for locally prevalent non-communicable, infectious and mental health conditions, alongside cognitive impairments, disabilities and frailty, using a combination of self-reported clinical diagnosis, symptom-based questionnaires, physical examinations and biochemical assays. We will conduct in-depth interviews with people with varying multimorbidity clusters, their informal carers and local healthcare providers. Deidentified data will be made available to external researchers. ETHICS AND DISSEMINATION: The study has received approval from the ethics committees of the National Institute of Nutrition and Indian Institute of Public Health Hyderabad, India and the London School of Hygiene and Tropical Medicine, UK. Meta-data and data collection instruments will be published on the APCAPS website alongside details of existing APCAPS data and the data access process (www.lshtm.ac.uk/research/centres-projects-groups/apcaps).

Development of a tool to estimate sugar and caloric contents in alcoholic beverages for a diabetes self-management program in Thailand.

Diabetes self-management education and support (DSMES) is recommended as a standard of care for patients with diabetes worldwide. Alcohol consumption is one aspect mentioned within the DSMES program in Thailand where alcohol consumption is the highest among Southeast Asian countries. Many diabetes guidelines suggest limiting alcohol intake to not more than one standard drink per day for adult women and two for adult men if they cannot abstain from drinking. In practice, however, the conversion of alcohol consumption into standard drinks, and nutritional information about the calorie and sugar contents of alcoholic beverages, especially domestically produced spirits, are not commonly available in Thailand. By reviewing the diabetes guidelines internationally and the Thailand alcoholic beverage industry, a visual health education tool to help convert different alcoholic beverages into standard drinks and to provide the calorie and sugar content of alcoholic beverages was developed as a part of the DSMES program. It was finalized following pilot testing and focus group discussions with policymakers, healthcare providers, and type 2 diabetes patients. The personalized counseling tool, integrated with guidelines and culturally tailored to the Thai setting is distributed to counselors/educators. It is a potentially useful tool for patients to make informed choices for their self-management of diabetes.

Effect of Yoga on Endothelial Function: A Systematic Review and Meta-Analysis.

Introduction: Endothelial dysfunction is the initial step in the pathogenesis of atherosclerosis; and it plays a central role in the development of cardiovascular diseases and many types of human diseases (diabetes, kidney failure, cancer, and viral infections). Strategies that are effective in protecting vascular endothelial function and retard or reversing endothelial dysfunction in the early stage appear to be potential in the prevention of vascular, cardiac, and many human diseases. Several studies have been carried out on the effects of yoga on endothelial function, but the results of these studies have not been synthesized. This study aimed at conducting a systematic review and meta-analysis to determine the effectiveness of yoga on endothelial function. Methods: A systematic review and meta-analysis of studies that assessed the effect of yoga practice on vascular endothelial function was done as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scopus, Google Scholar, and Cochrane controlled register of trials (CENTRAL) were searched from inception to August 2022. The search strategy was constructed around yoga-based techniques and endothelial function. All the yoga-based interventional studies on endothelial function or dysfunction were included in this review. A narrative synthesis and descriptive analysis were done due to the diverse methodology of selected studies. We carried out a formal meta-analysis of controlled trials that assessed the effect of yoga on flow-mediated dilatation (FMD), a measure of endothelial function. Results: A total of 18 studies were included for review involving 1043 participants. Yoga training showed improved endothelial function in 12 studies, whereas 6 studies did not find any statistically robust effect. Meta-analysis (n = 395 participants, 6-studies, 7 comparisons) showed an increase in brachial FMD by yoga practice (mean difference = -1.23%; 95% confidence interval -2.23 to -0.23; p = 0.02). The heterogeneity between the studies was 43% (Tau2 = 0.70, χ2 = 10.49). The risk of bias was low to moderate in these studies. No adverse effects were reported. Conclusions: Yoga practice improved endothelial function. Yoga could be a safe and potential integrative medicine to improve endothelial function. However, as the statistical heterogeneity, that is, variation in the FMD among the studies was moderate, large clinical trials are necessary for its clinical recommendations.

Yoga Programme for Type 2 Diabetes Prevention (YOGA-DP): A Qualitative Study Exploring the Trial Team's Facilitators and Challenges in Conducting a Feasibility Trial in India.

BACKGROUND: In India, around 77 million people are at high risk of developing type 2 diabetes mellitus (T2DM). Yoga interventions can be effective in preventing T2DM. We conducted a feasibility randomized controlled trial (RCT) in India, and the intervention was the Yoga Programme for T2DM Prevention (YOGA-DP). This study aimed to identify and explore the facilitators and challenges in conducting the feasibility trial in India, and more specifically, to explore the perceptions and experiences of trial staff in relation to running the feasibility trial and Yoga instructors in relation to delivering the intervention. METHODS: An exploratory qualitative study was conducted at two trial sites in India (Yoga centers in New Delhi and Bengaluru). Semi-structured interviews were conducted with ten participants (six trial staff and four Yoga instructors) to explore their perceptions and experiences related to the study's aim. Data were analyzed using deductive as well as inductive logic and an interpretative phenomenological approach. RESULTS: Feasibility-trial-related facilitators were useful participant recruitment strategies and help and support received from the trial coordination center. Intervention-related facilitators were strengths of the intervention content, structure, and delivery (including materials) and competencies of Yoga instructors. Feasibility-trial-related challenges were lack of awareness about T2DM among potential participants, stigma and fear associated with T2DM among potential participants, difficulties in explaining the research and obtaining written informed consent from potential participants, expectations and demands of potential participants and control-group participants, gender and language issues in participant recruitment, other participant recruitment-related challenges, issues in participant follow-up, and issues in data collection and trial documentation. Intervention-related challenges were the limited interest of participants in Yoga, participants' time constraints on practicing Yoga, participants' health issues hindered Yoga practice, beginners' difficulties with practicing Yoga, participants' demotivation to practice Yoga at home, issues with the Yoga practice venue, confusion regarding the intervention structure, issues with intervention materials, and the incompetence of Yoga instructors. CONCLUSIONS: The perceptions and experiences of trial staff and Yoga instructors helped us to understand the facilitators and challenges in running a feasibility trial and delivering the intervention for T2DM prevention, respectively. These findings and their suggestions will be used when designing the definitive RCT for evaluating YOGA-DP's effectiveness, and may be helpful to researchers planning similar trials. TRIAL REGISTRATION NUMBER: India (CTRI) CTRI/2019/05/018893.

Statistical analysis plan and protocol updates for Gestational diabetes in Uganda and India: Design and Evaluation of Educational Films for Improving Screening and Self-management (GUIDES) trial.

BACKGROUND: Timely detection and management of gestational diabetes mellitus (GDM) have been identified as a high priority for policymakers in low- and middle-income countries (LMICs). The GUIDES trial will evaluate a package of three interconnected film-based interventions aimed at improving the timely detection and management of GDM. The protocol for this trial has previously been published; this publication outlines the statistical analysis plan for the trial. METHODS AND DESIGN: The GUIDES study is a multi-country cluster-randomised controlled trial consisting of one trial conducted in Uganda and one in India (30 clusters in each country). Mixed effects models will be used to compare the primary study outcomes of the proportion of women who are tested for GDM between 24 and 32 weeks of pregnancy and the mean fasting blood sugar of women with GDM at 34-week follow-up while accounting for clustering. Secondary analyses will compare the proportion of women with self-reported GDM diagnosis at 32 weeks of pregnancy and the proportion of women with adverse perinatal outcomes related to GDM up to 4 weeks after birth in each trial arm. TRIAL STATUS AND DISCUSSION: Follow-up is expected to end in March 2023 in Uganda and in May 2023 in India. Analyses will be carried out following this statistical analysis plan in the month following trial completion. TRIAL REGISTRATION: ClinicalTrials.gov NCT03937050. Registered on 3 May 2019. Clinical Trials Registry India CTRI/2020/02/023605. Registered on 26 February 2020.

Impact of a financial incentive scheme on purchase of fruits and vegetables from unorganised retailers in rural India: a cluster-randomised controlled trial.

Background: Inadequate intake of fruits and vegetables is prevalent in rural areas of India, where around 65% of the population reside. Financial incentives have been shown to increase the purchase of fruits and vegetables in urban supermarkets, but their feasibility and effectiveness with unorganised retailers in rural India is unclear. Methods: A cluster-randomised controlled trial of a financial incentive scheme involving ∼20% cashback on purchase of fruits and vegetables from local retailers was conducted in six villages (3535 households). All households in three intervention villages were invited to participate in the scheme which ran for three months (February-April 2021), while no intervention was offered in control villages. Self-reported (pre-intervention and post-intervention) data on purchase of fruits and vegetables were collected from a random sub-sample of households in control and intervention villages. Findings: A total of 1109 households (88% of those invited) provided data. After the intervention, the weekly quantity of self-reported fruits and vegetables purchased were (i) 18.6 kg (intervention) and 14.2 kg (control), baseline-adjusted mean difference 4 kg (95% CI: -6.4 to 14.4) from any retailer (primary outcome); and (ii) 13.1 kg (intervention) and 7.1 kg (control), baseline-adjusted mean difference 7.4 kg (95% CI: 3.8-10.9) from local retailers participating in the scheme (secondary outcome). There was no evidence of differential effects of the intervention by household food security or by socioeconomic position, and no unintended adverse consequences were noted. Interpretation: Financial incentive schemes are feasible in unorganised food retail environments. Effectiveness in improving diet quality of the household likely hinges on the percentage of retailers willing to participate in such a scheme. Funding: This research has been funded by the Drivers of Food Choice (DFC) Competitive Grants Program, which is funded by the UK Government's Department for International Development and the Bill & Melinda Gates Foundation, and managed by the University of South Carolina, Arnold School of Public Health, USA; however, the views expressed do not necessarily reflect the UK Government's official policies.

The Integration of Clinical Decision Support Systems Into Telemedicine for Patients With Multimorbidity in Primary Care Settings: Scoping Review.

BACKGROUND: Multimorbidity, the presence of more than one condition in a single individual, is a global health issue in primary care. Multimorbid patients tend to have a poor quality of life and suffer from a complicated care process. Clinical decision support systems (CDSSs) and telemedicine are the common information and communication technologies that have been used to reduce the complexity of patient management. However, each element of telemedicine and CDSSs is often examined separately and with great variability. Telemedicine has been used for simple patient education as well as more complex consultations and case management. For CDSSs, there is variability in data inputs, intended users, and outputs. Thus, there are several gaps in knowledge about how to integrate CDSSs into telemedicine and to what extent these integrated technological interventions can help improve patient outcomes for those with multimorbidity. OBJECTIVE: Our aims were to (1) broadly review system designs for CDSSs that have been integrated into each function of telemedicine for multimorbid patients in primary care, (2) summarize the effectiveness of the interventions, and (3) identify gaps in the literature. METHODS: An online search for literature was conducted up to November 2021 on PubMed, Embase, CINAHL, and Cochrane. Searching from the reference lists was done to find additional potential studies. The eligibility criterion was that the study focused on the use of CDSSs in telemedicine for patients with multimorbidity in primary care. The system design for the CDSS was extracted based on its software and hardware, source of input, input, tasks, output, and users. Each component was grouped by telemedicine functions: telemonitoring, teleconsultation, tele-case management, and tele-education. RESULTS: Seven experimental studies were included in this review: 3 randomized controlled trials (RCTs) and 4 non-RCTs. The interventions were designed to manage patients with diabetes mellitus, hypertension, polypharmacy, and gestational diabetes mellitus. CDSSs can be used for various telemedicine functions: telemonitoring (eg, feedback), teleconsultation (eg, guideline suggestions, advisory material provisions, and responses to simple queries), tele-case management (eg, sharing information across facilities and teams), and tele-education (eg, patient self-management). However, the structure of CDSSs, such as data input, tasks, output, and intended users or decision-makers, varied. With limited studies examining varying clinical outcomes, there was inconsistent evidence of the clinical effectiveness of the interventions. CONCLUSIONS: Telemedicine and CDSSs have a role in supporting patients with multimorbidity. CDSSs can likely be integrated into telehealth services to improve the quality and accessibility of care. However, issues surrounding such interventions need to be further explored. These issues include expanding the spectrum of medical conditions examined; examining tasks of CDSSs, particularly for screening and diagnosis of multiple conditions; and exploring the role of the patient as the direct user of the CDSS.

Yoga Programme for Type 2 Diabetes Prevention (YOGA-DP) Among High-Risk People in India: A Multicenter Feasibility Randomized Controlled Trial.

INTRODUCTION: Many Indians are at high risk of type 2 diabetes mellitus (T2DM). The blood glucose level can be improved through a healthy lifestyle (such as physical activity and a healthy diet). Yoga can help in T2DM prevention, being a culturally appropriate approach to improving lifestyle. We developed the Yoga Programme for T2DM Prevention (YOGA-DP), a 24-week structured lifestyle education and exercise (Yoga) program that included 27 group Yoga sessions and self-practice of Yoga at home. In this study, the feasibility of undertaking a definitive randomized controlled trial (RCT) was explored that will evaluate the intervention's effectiveness among high-risk individuals in India. METHODS: A multicenter, two-arm, parallel-group, feasibility RCT was conducted in India. The outcome assessors and data analysts were blinded. Adults with a fasting blood glucose level of 100-125 mg/dL (i.e., at high risk of T2DM) were eligible. Participants were randomized centrally using a computer-generated randomization schedule. In the intervention group, participants received YOGA-DP. In the control group, participants received enhanced standard care. RESULTS: In this feasibility trial, the recruitment of participants took 4 months (from May to September 2019). We screened 711 people and assessed 160 for eligibility. Sixty-five participants (33 in the intervention group and 32 in the control group) were randomized, and 57 (88%) participants were followed up for 6 months (32 in the intervention group and 25 in the control group). In the intervention group, the group Yoga sessions were continuously attended by 32 (97%) participants (median (interquartile range, IQR) number of sessions attended = 27 (3)). In the intervention group, Yoga was self-practiced at home by 30 (91%) participants (median (IQR) number of days per week and minutes per day self-practiced = 2 (2) and 35 (15), respectively). In the control group, one (3%) participant attended external Yoga sessions (on Pranayama) for 1 week during the feasibility trial period. There was no serious adverse event. CONCLUSIONS: The participant recruitment and follow-up and adherence to the intervention were promising in this feasibility study. In the control group, the potential contamination was low. Therefore, it should be feasible to undertake a definitive RCT in the future that will evaluate YOGA-DP's effectiveness among high-risk people in India. FEASIBILITY TRIAL REGISTRATION: Clinical Trials Registry-India (CTRI) CTRI/2019/05/018893; registered on May 1, 2019.

Development process of a clinical guideline to manage type 2 diabetes in adults by Ayurvedic practitioners.

Background: Type 2 diabetes mellitus (T2DM), a common chronic health condition, has major health and socioeconomic consequences. In the Indian subcontinent, it is a health condition for which individuals commonly consult Ayurvedic (traditional medical system) practitioners and use their medicines. However, to date, a good quality T2DM clinical guideline for Ayurvedic practitioners, grounded on the best available scientific evidence, is not available. Therefore, the study aimed to systematically develop a clinical guideline for Ayurvedic practitioners to manage T2DM in adults. Methods: The development work was guided by the UK's National Institute for Health and Care Excellence (NICE) manual for developing guidelines, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. First, a comprehensive systematic review was conducted which evaluated Ayurvedic medicines' effectiveness and safety in managing T2DM. In addition, the GRADE approach was used for assessing the certainty of the findings. Next, using the GRADE approach, the Evidence-to-Decision framework was developed, and we focused on glycemic control and adverse events. Subsequently, based on the Evidence-to-Decision framework, a Guideline Development Group of 17 international members made recommendations on Ayurvedic medicines' effectiveness and safety in T2DM. These recommendations formed the basis of the clinical guideline, and additional generic content and recommendations were adapted from the T2DM Clinical Knowledge Summaries of the Clarity Informatics (UK). The feedback given by the Guideline Development Group on the draft version was used to amend and finalize the clinical guideline. Results: A clinical guideline for managing T2DM in adults by Ayurvedic practitioners was developed, which focuses on how practitioners can provide appropriate care, education, and support for people with T2DM (and their carers and family). The clinical guideline provides information on T2DM, such as its definition, risk factors, prevalence, prognosis, and complications; how it should be diagnosed and managed through lifestyle changes like diet and physical activity and Ayurvedic medicines; how the acute and chronic complications of T2DM should be detected and managed (including referral to specialists); and advice on topics like driving, work, and fasting including during religious/socio-cultural festivals. Conclusion: We systematically developed a clinical guideline for Ayurvedic practitioners to manage T2DM in adults.

Global, regional and national prevalence of copper, selenium and zinc deficiencies in women of childbearing age: protocol for systematic review and meta-analysis.

INTRODUCTION: Micronutrient deficiencies are common in low-income and middle-income countries and are usually related to inadequate food intake, poor diet quality and low bioavailability. Copper, selenium and zinc are essential minerals in several enzymatic reactions and their deficiencies are associated with worse prognosis in pregnancy, compromising maternal health as well as her offspring. Thus, the objective of the present systematic review will be to describe the prevalence of copper, selenium and zinc deficiencies in women of childbearing age. METHODS AND ANALYSIS: The search will be performed by independent reviewers. The bases used will be PubMed/MEDLINE, Science direct, Lilacs, Adolec, Scopus, EMBASE, CINAHL, Web of Science, CENTRAL, IMSEAR, PAHOS, WPRIM, IMEMR, AIM for grey literature OpenGrey and OVID. National data will be searched in BDTD. A first search will be performed and a second search will be performed just before submission. Risk of bias assessment will be performed using the Joanna Briggs group prevalence study checklist. Combinable studies will be performed meta-analysis. Heterogeneity will be tested using Cochran's Q test and quantified by the inconsistency test (I²). In the presence of high heterogeneity, meta-analysis will be performed using the random effects model with Stata metaprop. Summary prevalence will be generated for each outcome, presented in Forest plot figures. ETHICS AND DISSEMINATION: This systematic review will be solely based on published and retrievable literature, no ethics approval will be obtained. Our dissemination strategy will involve the presentation in scientific meetings, as well as the publication of article(s), posters and presentations in congresses. PROSPERO REGISTRATION NUMBER: CRD42020165352.

Sleep behaviors and Parkinson's disease: A bidirectional Mendelian randomization analysis.

OBJECTIVE: Whether the quantity and quality of sleep are the risk factors for the development of Parkinson's disease remains unclear though it has now been confirmed that the quality of sleep among patients with Parkinson's disease is affected at the prodromal and clinical stages. Accordingly, this study aimed to examine the bidirectional causal relationships of multiple sleep-related phenotypes with Parkinson's disease using a two-sample Mendelian randomization (MR) method. METHODS: The summary-level data collected from the published genome-wide association studies was used for analysis. Besides, the genetic relationships between different sleep-related phenotypes, including self-reported and accelerometer measured traits, were estimated for the risk and age at the onset of Parkinson's disease. To conduct MR analysis, inverse variance weighted, weight median, MR-Egger, and MR-PRESSO method were mainly used. Moreover, sensitivity analyses were carried out to examine the pleiotropic effect. RESULTS: In general, there was insufficient evidence to support the causal effect of sleep-related phenotypes on risk (N cases/controls = 33,674/449,056) and age at the onset (N cases = 28,568) of Parkinson's disease. However, the results of this study indicated that the later onset age of Parkinson's disease was related to the frequent occurrence of insomnia (OR [95% CI] 1.007 [1.003, 1.011], P < 0.001) after the adjustment for multiple testing. CONCLUSIONS: The results of this study suggest that insomnia-associated single nucleotide polymorphisms are more frequent in later onset Parkinson's disease patients compared to earlier onset patients. However, given the limitations of statistical power and potential bias, further validation should be still conducted through larger population research.

[Body image is associated with anthropometric status in adolescents, but not with lifestyle]. / Imagem corporal está associada com estado antropométrico em adolescentes, mas não com estilo de vida.

Body image is a construct of the multifaceted representation of body identity that involves self-perception, beliefs, attitudes about the body itself, which can be influenced by several factors. This study evaluated the association of body image with anthropometric and lifestyle indicators among adolescents. The sample comprised 465 adolescents aged 10 to 17 years from public schools in the city of Salvador-Bahia. The Silhouettes Scale assessed the body image. The anthropometric data (body mass index and waist circumference), the lifestyle (Physical Activity Questionnaire for Adolescents and television time), economic and demographic data were evaluated. Polytomous logistic regression assessed associations of interest by STATA, version 16.0. Overweight (OR:9,7; CI95%:5,4-17,5) and abdominal obesity (OR:14,0; CI95%: 5,0-39,3) were positively associated with body dissatisfaction. However, there was no association with lifestyle variables (physical activity: OR: 1,7, CI: 0,9-2,9, and TV time: OR:1,2; CI:0,8-1,9). The conclusion reached is that anthropometric status is an essential indicator of adverse body image outcomes in adolescents.

A imagem corporal é um constructo da representação multifacetada da identidade corporal, envolve autopercepção, crenças e atitudes sobre o próprio corpo, podendo ser influenciada por diversos fatores. Este estudo avaliou a associação da imagem corporal com indicadores antropométricos e do estilo de vida em adolescentes. Constituíram a amostra 465 adolescentes de 10 a 17 anos de escolas públicas da cidade de Salvador, na Bahia. A imagem corporal foi avaliada pela Escala de Silhuetas. Os dados antropométricos (índice de massa corporal e a circunferência da cintura), de estilo de vida (Physical Activity Questionnaire for Adolescents e o tempo de televisão), econômicos e demográficos foram avaliados. Regressão logística politômica avaliou as associações de interesse. Os dados foram analisados pelo software STATA, versão 16.0. O sobrepeso/obesidade (OR: 9,7; IC95%: 5,4-17,5) e a obesidade abdominal (OR: 14,0; IC95%: 5,0-39,3) se mostraram positivamente associados à insatisfação corporal, mas não foi observada associação com as variáveis de estilo de vida (atividade física: OR: 1,7; IC95%: 0,9-2,9; e tempo de TV: OR: 1,2; IC95%: 0,8-1,9). Conclui-se que o estado antropométrico é um importante indicador dos desfechos negativos da imagem corporal em adolescentes.

Sex-specific associations between markers of arterial stiffness and bone mineral density in Indian men and women.

BACKGROUND: Osteoporosis and cardiovascular disease (CVD) share common risk factors, yet both are usually underdiagnosed in the absence of major complications. We investigated associations between arterial stiffness, cardiac workload, carotid intima media thickness (CIMT) and areal bone mineral density (aBMD) in Indian adults. METHODS: Men and women aged >45 years from the Andhra Pradesh Children and Parents Study (APCAPS) were included for cross-sectional analysis (521 women and 696 men). Dual energy x-ray absorptiometry (DXA) measured aBMD at the whole body, total hip and lumbar spine. Supine blood pressure and heart rate were measured and used to calculate rate pressure product and pulse pressure; augmentation index, pulse wave velocity and CIMT were measured. Sex-interactions were tested (denoted as p-int); adjustments were made for confounders. Data were expressed as SD differences with 95 % confidence intervals. RESULTS: There were significant negative associations between pulse pressure and aBMD at all sites in women only. In unadjusted analyses, for every 1SD increase in pulse pressure, women had greater negative differences in aBMD at the whole body (-0.13 vs 0.007), total hip (-0.20 vs -0.05) and lumbar spine (-0.12 vs 0.05) compared with men. After adjustments, sex differences remained. Similar negative associations were seen between pulse wave velocity and augmentation index with aBMD in women only. There were no sex differences between CIMT and rate pressure product with aBMD. CONCLUSIONS: Markers of arterial stiffness are associated with poorer bone health in Indian women, but not in men. There is a need to identify the shared risk factors and markers of arterial stiffness and poor bone health to detect those who require co-management of these diseases to prevent cardiovascular events and fractures.

Imagem corporal está associada com estado antropométrico em adolescentes, mas não com estilo de vida / Body image is associated with anthropometric status in adolescents, but not with lifestyle

Resumo A imagem corporal é um constructo da representação multifacetada da identidade corporal, envolve autopercepção, crenças e atitudes sobre o próprio corpo, podendo ser influenciada por diversos fatores. Este estudo avaliou a associação da imagem corporal com indicadores antropométricos e do estilo de vida em adolescentes. Constituíram a amostra 465 adolescentes de 10 a 17 anos de escolas públicas da cidade de Salvador, na Bahia. A imagem corporal foi avaliada pela Escala de Silhuetas. Os dados antropométricos (índice de massa corporal e a circunferência da cintura), de estilo de vida (Physical Activity Questionnaire for Adolescents e o tempo de televisão), econômicos e demográficos foram avaliados. Regressão logística politômica avaliou as associações de interesse. Os dados foram analisados pelo software STATA, versão 16.0. O sobrepeso/obesidade (OR: 9,7; IC95%: 5,4-17,5) e a obesidade abdominal (OR: 14,0; IC95%: 5,0-39,3) se mostraram positivamente associados à insatisfação corporal, mas não foi observada associação com as variáveis de estilo de vida (atividade física: OR: 1,7; IC95%: 0,9-2,9; e tempo de TV: OR: 1,2; IC95%: 0,8-1,9). Conclui-se que o estado antropométrico é um importante indicador dos desfechos negativos da imagem corporal em adolescentes.

Abstract Body image is a construct of the multifaceted representation of body identity that involves self-perception, beliefs, attitudes about the body itself, which can be influenced by several factors. This study evaluated the association of body image with anthropometric and lifestyle indicators among adolescents. The sample comprised 465 adolescents aged 10 to 17 years from public schools in the city of Salvador-Bahia. The Silhouettes Scale assessed the body image. The anthropometric data (body mass index and waist circumference), the lifestyle (Physical Activity Questionnaire for Adolescents and television time), economic and demographic data were evaluated. Polytomous logistic regression assessed associations of interest by STATA, version 16.0. Overweight (OR:9,7; CI95%:5,4-17,5) and abdominal obesity (OR:14,0; CI95%: 5,0-39,3) were positively associated with body dissatisfaction. However, there was no association with lifestyle variables (physical activity: OR: 1,7, CI: 0,9-2,9, and TV time: OR:1,2; CI:0,8-1,9). The conclusion reached is that anthropometric status is an essential indicator of adverse body image outcomes in adolescents.

Association between occupational stress, work shift and health outcomes in hospital workers of the Recôncavo of Bahia, Brazil: the impact of COVID-19 pandemic.

The aim of this study was to ascertain the level of occupational stress before and during the COVID-19 pandemic, how it changed and its association with health outcomes of hospital workers in the Recôncavo of Bahia, Brazil. A longitudinal study was conducted with 218 hospital workers over 18 years old. A semi-structured questionnaire was used for collecting sociodemographic, occupational, lifestyle, anthropometric and health data. The main exposures were occupational stress, assessed through Job Content Questionnaire and classified according to the Demand-Control Model and reported shift work. Health outcomes considered were nutritional status assessed by BMI, waist circumference and body fat percentage, health self-perception and cardiovascular risk factors. We used McNemar χ2 or Wilcoxon tests to compare the levels of exposure and outcome variables before and during the pandemic, and OR to evaluate associations between changes in occupational stress and shift work with health outcomes. During the pandemic, participants reported increased occupational stress and shift work and lower self-perceived health and had higher BMI and cardiovascular risk factors, compared with before the pandemic. No association was observed between change in occupational stress and health outcomes. However, increased amount of shift work was related to increased BMI in the overall sample (OR 3·79, 95 % CI (1·40, 10·30)) and in health workers (OR 11·56; 95 % CI (2·57, 52·00)). These findings support calls to strengthen labour policies to ensure adequate working conditions for hospital workers in context of the COVID-19 pandemic.