Glycaemic sugar metabolism and the gut microbiota: past, present and future.

Non-communicable diseases (NCDs), such as type 2 diabetes (T2D) and metabolic dysfunction-associated fatty liver disease, have reached epidemic proportions worldwide. The global increase in dietary sugar consumption, which is largely attributed to the production and widespread use of cheap alternatives such as high-fructose corn syrup, is a major driving factor of NCDs. Therefore, a comprehensive understanding of sugar metabolism and its impact on host health is imperative to rise to the challenge of reducing NCDs. Notably, fructose appears to exert more pronounced deleterious effects than glucose, as hepatic fructose metabolism induces de novo lipogenesis and insulin resistance through distinct mechanisms. Furthermore, recent studies have demonstrated an intricate relationship between sugar metabolism and the small intestinal microbiota (SIM). In contrast to the beneficial role of colonic microbiota in complex carbohydrate metabolism, sugar metabolism by the SIM appears to be less beneficial to the host as it can generate toxic metabolites. These fermentation products can serve as a substrate for fatty acid synthesis, imposing negative health effects on the host. Nevertheless, due to the challenging accessibility of the small intestine, our knowledge of the SIM and its involvement in sugar metabolism remains limited. This review presents an overview of the current knowledge in this field along with implications for future research, ultimately offering potential therapeutic avenues for addressing NCDs.

Built environment and childhood obesity.

Childhood obesity, an escalating global health challenge, is intricately linked to the built environment in which children live, learn, and play. This review and perspective examined the multifaceted relationship between the built environment and childhood obesity, offering insights into potential interventions for prevention. Factors such as urbanization, access to unhealthy food options, sedentary behaviors, and socioeconomic disparities are critical contributors to this complex epidemic. Built environment encompasses the human-modified spaces such as homes, schools, workplaces, and urban areas. These settings can influence children's physical activity levels, dietary habits, and overall health. The built environment can be modified to prevent childhood obesity by enhancing active transportation through the development of safe walking and cycling routes, creating accessible and inviting green spaces and play areas, and promoting healthy food environments by regulating fast-food outlet density. School design is another area for intervention, with a focus on integrating outdoor spaces and facilities that promote physical activity and healthy eating. Community engagement and education in reinforcing healthy behaviors is necessary, alongside the potential of technology and innovation in encouraging physical activity among children. Policy and legislative support are crucial for sustaining these efforts. In conclusion, addressing the built environment in the fight against childhood obesity requires the need for a comprehensive, multipronged approach that leverages the built environment as a tool for promoting healthier lifestyles among children, ultimately paving the way for a healthier, more active future generation.

Changes in the incidence of type 2 diabetes in Australia, 2005-2019, overall and by socio-demographic characteristics: a population-based study.

OBJECTIVES: To estimate changes in the incidence of clinically diagnosed type 2 diabetes in Australia, overall and by age, sex, socio-economic disadvantage, geographic remoteness, and country of birth. STUDY DESIGN: Population-based study; analysis of National Diabetes Services Scheme (NDSS) data (age-period-cohort models). SETTING, PARTICIPANTS: Data were extracted for incident cases of type 2 diabetes, 1 January 2005 to 31 December 2019, in residents of the Australian Capital Territory, New South Wales, Queensland, and Victoria aged 20 years or older registered with the NDSS. The numbers of people at risk were obtained from the Australian Bureau of Statistics. MAIN OUTCOME MEASURES: Changes in the incidence of type 2 diabetes, 2005-2019, by age, postcode-level socio-economic disadvantage (Index of Relative Socioeconomic Disadvantage) and remoteness (major city, inner regional, outer regional/remote/very remote), and country of birth, stratified by sex. RESULTS: During 2005-2019, 741 535 people aged 20 years or older with incident type 2 diabetes were registered with the NDSS; 421 190 were men (56.8%). Overall, the incidence of type 2 diabetes increased with age (until about age 70 years) and socio-economic disadvantage for both sexes; it was higher in inner regional areas than in major cities or outer regional/remote/very remote areas during 2005-2015, but highest among people in major cities after 2015. The age-standardised incidence of type 2 diabetes increased during 2005-2010, both among men (annual percentage change [APC], 4.4%; 95% confidence interval [CI], 3.6-5.2%) and women (APC, 2.9%; 95% CI, 2.2-3.7%); it declined during 2010-2019 among both men (APC, -5.2%; 95% CI, -5.4% to -4.9%) and women (APC, -6.5%; 95% CI, -6.8% to -6.2%). In general, similar patterns (but of differing magnitude) applied to all age, sex, socio-economic disadvantage, and remoteness groups. However, the incidence of type 2 diabetes increased during 2011-2019 among people born in Asia, North Africa and the Middle East, and the Pacific Islands. CONCLUSIONS: The incidence of type 2 diabetes in Australian adults declined during 2010-2019 across all age, sex, socio-economic disadvantage, and remoteness groups, but increased among people from Asia, North Africa and the Middle East, and the Pacific Islands.

Prevalence of metabolic syndrome among adults treated at a district hospital outpatient department.

BACKGROUND:  Metabolic syndrome (MetS) is a collection of risk factors, including hypertension, high fasting blood glucose, high fasting triglyceride and low high-density lipoprotein (HDL) cholesterol levels that may increase the risk for cardiovascular disease and type 2 diabetes. The study aimed to determine the prevalence of MetS among adults attending a Free State district hospital's outpatient department. METHODS:  A cross-sectional study included a consecutive sample of consenting patients 18 years and older from 18 October 2021 to 19 November 2021. Patients' waist circumference was measured, and data were extracted from patients' files. RESULTS:  The 409 participants were predominantly females (64.2%). The median age was 60 years. Triglyceride and HDL cholesterol levels were available for 27.4% and 26.9% of patients, respectively. Of the 278 (68.0%) patients with sufficient information to determine their MetS status, 187 (67.3%) had MetS. Of the males with sufficient information, 49.1% (n = 56/114) had MetS compared to 79.9% (n = 131/164) of the females with sufficient information (p  0.001). The age group 60-79 years had the highest prevalence (76.7%, p  0.001). In all race groups, at least two-thirds of patients had MetS (p = 0.831). CONCLUSION:  Incomplete patient notes and failure to do investigations led to a third of patients not having sufficient information to determine their MetS status. In patients with sufficient information, a high prevalence of MetS was found.Contribution: This study highlights the challenges of determining MetS retrospectively in an outpatient population and the need for completeness of medical note keeping and routine investigations in high-risk patients. It also notes the high prevalence of MetS.

Role of diet in development of non-communicable diseases: focus on gut microbiome.

OBJECTIVES: The dietary composition is able to rapidly and significantly influence the diversity of the gut microbiome. This article focuses on how various types of diet affect the composition of the gut microbiome and how dietary changes are able to prevent or slow down the development of non-communicable diseases including obesity, type 2 diabetes mellitus, cardiovascular diseases, and low-grade inflammation. METHODS: A review in PubMed and a hand search using references in identified articles were performed. Studies published in English from 2000 to 2024 were included. RESULTS: The studies showed the significant effect of diet on the development of non-communicable diseases dependent on the state of the gut microbiota and molecules it produces. The Western diet that continues to gain in popularity for Czech people, leads to dysbiosis and production of bacterial lipopolysaccharide or trimethylamine N-oxide causing systemic chronic inflammation in the body and thus promoting the development of non-communicable diseases. CONCLUSIONS: Findings from this review emphasize the importance of healthy eating habits in the prevention of intestinal dysbiosis and still increasing prevalence and incidence of obesity and other non-communicable diseases.

Burden of non-communicable diseases attributable to high temperature in a changing climate from 1990 to 2019: a global analysis.

BACKGROUND: With global climate change, the health threats of ambient high temperature have received widespread attention. However, latest spatio-temporal patterns of the non-communicable diseases (NCDs) burden attributable to high temperature have not been systematically reported. We aimed to analyze vulnerable areas and populations based on a detailed profile for the NCDs burden attributable to high temperature globally. METHODS: We obtained data from the Global Burden of Diseases (GBD) Study (2019) to describe the temporal and spatial patterns of NCDs burden attributable to high temperature globally from 1990-2019. Then we analyzed the differences by region, sex, and socio-demographic index (SDI). Finally, the age­period­cohort (APC) model was utilized to explore the age, period, and cohort effects of NCDs mortality caused by high temperature. RESULTS: In 2019, the number of deaths and Disability-adjusted life years (DALYs) from high-temperature-related NCDs was about 150,000 and 3.4 million globally, of which about 70% were in South Asia and North Africa and Middle East, and the burden was higher in men. Among 204 countries and territories, the highest age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were observed in Oman and United Arab Emirates, respectively. The global burden showed an upward trend from 1990 to 2019, with an EAPC of 3.66 (95%CI: 3.14-4.18) for ASMR and 3.68 (95%CI: 3.16-4.21) for ASDR. Cardiovascular diseases were the main contributors to the global burden of high-temperature-related NCDs in 2019. The age and period effect in APC model showed an increasing trend globally. There was a significant negative correlation between SDI and both ASMR (r = -0.17) and ASDR (r = -0.20) from 1990 to 2019. CONCLUSION: There was an increasing trend of the global burden of high-temperature-related NCDs. The burden was likely to be higher in males and the elderly, as well as in countries and regions with less economically and socially developed and in tropical climates. Surveillance and prevention measures should be implemented with a focus on these vulnerable areas and susceptible populations.

Lifestyle Medicine and Japan's Longevity Miracle.

With Japan's economic growth, its life expectancy increased from 1965, and since 1980, Japan has become one of the longest-lived countries in the world. Strong government-led initiatives such as low-cost health insurance, widely distributed health screenings, a new law to prevent non-communicable diseases established in 1956, Shokuiku (Japanese culinary education), and stress-measuring systems in the workplace contributed to the population's longevity. In addition to these public initiatives, Japan has benefited from evolving lifestyle practices over its long history. These include Washoku (Japanese traditional food), which utilizes the complex interaction of individual nutrients unique to Japan as well as numerous metabolically active compounds, the interrelation of Japan's population levels with its plant-dominant diet, a mindful culture connected with nature, and the principle of hara-hachi-bu (Confucianism-based caloric restriction habit; "eat until 80% full"), and so on. In 2002, Japan took the remarkable action of stipulating by law that citizens must deepen their interest in and understanding of the importance of healthy lifestyle habits, be aware of their own health status, and strive to improve their health throughout their lives. Today, to protect its future, Japan must face a new challenge: a population that is declining and is the world's fastest-aging.

Unravelling the nexus of microfinance and women's non-communicable disease (NCD) health outcomes in Sri Lanka: An exploratory study.

ABSTRACTNon-communicable diseases (NCDs) are a major contributor to the global burden of disease, increasingly impacting low-income and marginalised populations in low- and middle-income countries such as Sri Lanka. Microfinance could be a potential approach to target NCDs. Using an ethnographic approach with thematic analysis, this study explored the nexus between microfinance and NCD outcomes. In-depth interviews were conducted with 29 micro-loan borrowing women across 15 field sites within Puttalam district in Sri Lanka. The findings revealed that perceived increases in income from microfinance loans contributed to enhanced household health savings ability, enabling the purchase of medicines bought out-of-pocket and from privately owned pharmacies, and spending for NCD-relevant health emergencies and health-related transportation. Additionally, perceived income increases also influenced the behavioural risks, including the spending and consumption of food, and physical activity levels, both positively and negatively. The microfinance networks also influenced women's perceived social support, psychological stress and coping mechanisms, and health information transmission, positively and negatively. The findings from this study provide important insights on how financial inclusion programs such as microfinance influence the health determinants and outcomes relevant to NCDs. This can help address ways to target both NCDs and inequities of socioeconomically disadvantaged and marginalised populations, particularly women.

Moving forward: scaling-up the integration of an HIV and hypertension program in Akwa Ibom State, Nigeria.

As people living with HIV experience increased life expectancy, there is a growing concern about the burden of comorbid non-communicable diseases, particularly hypertension. This brief describes the current policy landscape on the management of HIV and hypertension in Akwa Ibom State, Nigeria, stakeholder engagement meetings, and the resulting five policy recommendations rooted in an ongoing research study designed to integrate hypertension management into HIV care across primary health centers in the State. In order to identify the current gaps in integrated care, discussion sessions with three stakeholder groups (i.e., healthcare providers, patient advocacy groups, and policy makers) were held separately in November 2022. The discussions were purposed to brainstorm policy-level solutions for integrating hypertension into HIV treatment. After all the sessions were concluded, there were five recommendations provided by the stakeholders for integrating HIV and hypertension care in the Akwa Ibom State. Stakeholders unanimously agreed with the need to integrate hypertension care for HIV impacted communities in the State. Specifically, stakeholders recommended to: (1) engage retired community health nurses as mentors; (2) actively link communities to integrated care in clinics; (3) integrate hypertension management with HIV education; (4) expand health insurance accessibility; and (5) formally integrate hypertension management into primary healthcare centers in Akwa Ibom State.

Effect of PM2.5 on burden of mortality from non-communicable diseases in northern Thailand.

Background: Particulate pollution, especially PM2.5from biomass burning, affects public and human health in northern Thailand during the dry season. Therefore, PM2.5exposure increases non-communicable disease incidence and mortality. This study examined the relationship between PM2.5and NCD mortality, including heart disease, hypertension, chronic lung disease, stroke, and diabetes, in northern Thailand during 2017-2021. Methods: The analysis utilized accurate PM2.5data from the MERRA2 reanalysis, along with ground-based PM2.5measurements from the Pollution Control Department and mortality data from the Division of Non-Communicable Disease, Thailand. The cross-correlation and spearman coefficient were utilized for the time-lag, and direction of the relationship between PM2.5and mortality from NCDs, respectively. The Hazard Quotient (HQ) was used to quantify the health risk of PM2.5to people in northern Thailand. Results: High PM2.5 risk was observed in March, with peak PM2.5concentration reaching 100 µg/m3, with maximum HQ values of 1.78 ± 0.13 to 4.25 ± 0.35 and 1.45 ± 0.11 to 3.46 ± 0.29 for males and females, respectively. Hypertension significantly correlated with PM2.5levels, followed by chronic lung disease and diabetes. The cross-correlation analysis showed a strong relationship between hypertansion mortality and PM2.5at a two-year time lag in Chiang Mai (0.73) (CI [-0.43-0.98], p-value of 0.0270) and a modest relationship with chronic lung disease at Lampang (0.33) (a four-year time lag). The results from spearman correlation analysis showed that PM2.5concentrations were associated with diabetes mortality in Chiang Mai, with a coefficient of 0.9 (CI [0.09-0.99], p-value of 0.03704). Lampang and Phayao had significant associations between PM2.5 and heart disease, with coefficients of 0.97 (CI [0.66-0.99], p-value of 0.0048) and 0.90 (CI [0.09-0.99], p-value of 0.0374), respectively, whereas Phrae had a high coefficient of 0.99 on stroke.

The socio-environmental determinants of diabetes and their consequences.

AIMS: The intricate connections between health and the environment are often overlooked globally, yet they play a pivotal role in shaping our well-being. RESULTS: Astonishingly, environmental risk factors contribute to nearly 24% of the global disease burden, underscoring the critical impact of our surroundings on health. At the crossroads of this issue lies Diabetes, a rapidly growing non-communicable disease that highlights the delicate balance between human health and environmental sustainability. This epidemic offers a unique lens through which to explore how environmental factors contribute to the prevalence of Diabetes, revealing the complex interplay at work. Despite growing awareness, healthcare systems worldwide face challenges integrating environmental threats into more effective diabetes care strategies CONCLUSIONS: This perspective highlights the urgent need for collaborative efforts and innovative solutions that address the environmental dimensions of diabetes management. Doing so can build healthier communities and pave the way for a more sustainable future.

The gender gap in outpatient care for non-communicable diseases in Mexico between 2006 and 2022.

BACKGROUND: Equitable health service utilization is key to health systems' optimal performance and universal health coverage. The evidence shows that men and women use health services differently. However, current analyses have failed to explore these differences in depth and investigate how such gender disparities vary by service type. This study examined the gender gap in the use of outpatient health services by Mexican adults with non-communicable diseases (NCDs) from 2006 to 2022. METHODS: A cross-sectional population-based analysis of data drawn from National Health and Nutrition Surveys of 2006, 2011-12, 2020, 2021, and 2022 was performed. Information was gathered from 300,878 Mexican adults aged 20 years and older who either had some form of public health insurance or were uninsured. We assessed the use of outpatient health services provided by qualified personnel for adults who reported having experienced an NCD and seeking outpatient care in the 2 weeks before the survey. Outpatient service utilization was disaggregated into four categories: non-use, use of public health services from providers not corresponding to the user's health insurance, use of public health services from providers not corresponding to the user's health insurance, and use of private services. This study reported the mean percentages (with 95% confidence intervals [95% CIs]) for each sociodemographic covariate associated with service utilization, disaggregated by gender. The percentages were reported for each survey year, the entire study period, the types of service use, and the reasons for non-use, according to the type of health problem. The gender gap in health service utilization was calculated using predictive margins by gender, type of disease, and survey year, and adjusted through a multinomial logistic regression model. RESULTS: Overall, we found that women were less likely to fall within the "non-use" category than men during the entire study period (21.8% vs. 27.8%, P < 0.001). However, when taking into account the estimated gender gap measured by incremental probability and comparing health needs caused by NCDs against other conditions, compared with women, men had a 7.4% lower incremental likelihood of falling within the non-use category (P < 0.001), were 10.8% more likely to use services from providers corresponding to their health insurance (P < 0.001), and showed a 12% lower incremental probability of using private services (P < 0.001). Except for the gap in private service utilization, which tended to shrink, the others remained stable throughout the period analyzed. CONCLUSION: Over 16 years of outpatient service utilization by Mexican adults requiring care for NCDs has been characterized by the existence of gender inequalities. Women are more likely either not to receive care or resort to using private outpatient services, often resulting in catastrophic out-of-pocket expenses for them and their families. Such inequalities are exacerbated by the segmented structure of the Mexican health system, which provides health insurance conditional on formal employment participation. These findings should be considered as a key factor in reorienting NCD health policies and programs from a gender perspective.

Health-promoting behavior and its determinants towards non-communicable diseases among adult residents of the Gedeo zone, South Ethiopia: the application of the health belief model.

Background: Non-communicable diseases are becoming a challenge for the health care system in Ethiopia, which has suffered a double burden from infectious and rapidly increasing non-communicable diseases. However, there is little information on health-promoting behavior in the study settings. Thus, the purpose of this study was to determine health-promoting behaviors and its associated factors among adult's residents of Gedeo zone. Methods: A cross-sectional study was conducted among 705 adult residents of Gedeo zone, south Ethiopia, selected using a multi-stage sampling technique. Interviews administered through a structured questionnaire were used to collect the data. The data were entered using Kobo Collect and analyzed using Stata version 17. The baseline characteristics of the participants were summarized using descriptive statistics. The independent sample t-test and one-way ANOVA were used to compare two groups and more than two groups, respectively. Stepwise multiple linear regression analysis was used to identify the potential determinants of health-promoting behavior and its components. Statistically significant factors were declared at p-value of less than or equal to 0.05. Results: The overall means score for health-promoting behavior was 73.88 ± 16.79. Physical activity and spiritual growth had the lowest and highest mean scores, respectively. The variables: gender, marital status, education, family history of NCDs, health insurance status, perceived health status, knowledge of NCD risk factors, risk perception of NCDs, expected outcome, cues to action, and self-efficacy showed a statistically significant difference in overall health-promoting behavior. The total health-promoting behavior score was associated with age, gender, perceived health status, marital status, family history of NCDs, health insurance, knowledge of NCD risk factors, perceived threat, expected outcome, self-efficacy, and cues to action. Conclusion and recommendations: In the study, the mean score of health-promoting behaviors was low. Socio-demographic and economic variables, family history of NCD, perceived health status, knowledge of NCD risk factors, perceived threat, expected outcome, self-efficacy, and cues to action affect health-promoting behaviors. Therefore, the study suggests establishing health promotion programs to increase residents' awareness of health-promoting lifestyles, empower them to adopt healthy lifestyles, and improve health outcomes by increasing self-efficacy, providing education, and creating supportive environments.

Sedentarism and Chronic Health Problems.

Increased mechanization and technological advances have simplified our lives on the one hand and increased sedentary behaviors on the other hand, paving the way for emerging global health concerns, i.e., sedentarism, which could be the leading cause of all major chronic health problems worldwide. Sedentarism is a habitual behavior of choosing and indulging in low-energy expenditure activities (≤1.5 metabolic equivalents), such as chairtype (sitting, studying, traveling) or screen-type activities (TV, computers, mobile). With technological advancements, there is a significant transition in the lifestyles of people from being active (walking) to being more deskbound (sitting). Prolonged sitting can have unintended consequences for health with sitting time >7 h/d, leading to a 5% increase in all-cause mortality with each additional hour spent sitting (i.e., +7 h/d), while considering physical activity levels. This review will highlight how sedentarism is emerging as a major risk factor for the rising incidence of non-communicable diseases, especially among young adults and adults. Chronic diseases, such as obesity, diabetes, coronary heart disease, and cancer, are the leading causes of death worldwide. Hence, there is an urgent need for collective action to mitigate the burgeoning public health crisis posed by sedentarism in the 21st century. This paper intends to set in motion a call for all policymakers and public health professionals placed nationally or internationally to reach a consensus on ending sedentarism and provide viable resolutions for effective management of excessive sedentary behaviors and healthy adoption and maintenance of active lifestyles among individuals of all age groups.

Beyond Numbers: Decoding the Gendered Tapestry of Non-Communicable Diseases in India.

INTRODUCTION: Non-communicable diseases (NCDs) represent a major global health challenge, particularly in low- and middle-income countries like India, with significant gender disparities in mortality and disease burden. This study aims to investigate these disparities, using data from national health surveys, to inform gender-specific public health strategies and align with global health goals. METHODOLOGY: The study uses data from the Longitudinal Aging Study in India (LASI) and National Family Health Surveys (NFHS-4 and NFHS-5). RESULT: The results from the Longitudinal Ageing Study in India (LASI) and National Family Health Surveys (NFHS-4 and NFHS-5) indicate significant demographic and health-related variations among 65,562 participants. Key findings show gender disparities in lifestyle habits such as alcohol and tobacco use, and differences in health outcomes across age, education, and socioeconomic status. Notably, an increase in NCD prevalence, particularly hypertension and diabetes, was observed from NFHS-4 to NFHS-5, highlighting evolving health challenges in India. CONCLUSIONS: The study emphasizes the importance of gender in the prevalence and management of non-communicable diseases (NCDs) in India, advocating for public health strategies that address gender differences, socio-economic factors, and urban-rural disparities to achieve health equity.

Long-Haul Truck Drivers' Perceptions of Truck Stops and Rest Areas: Focusing on Health and Wellness.

The work and life routine of long-haul truck drivers (LHTDs) involve the use of truck stops and rest areas to meet their basic human needs. These extensions of their workspaces on the road do not always offer adequate physical structures and services that drivers need for optimal health. This study aimed to evaluate long-haul truck drivers' perceptions of food services, safety, physical activity, rest, and personal hygiene offered at truck stops and rest areas, as well as the correlation between these perceptions and sociodemographic, health, and work conditions variables. A cross-sectional, quantitative, and descriptive study was conducted with long-haul truck drivers from the southern region of Brazil. For data collection, a sociodemographic questionnaire and a Likert scale on food, rest, personal hygiene, safety, and physical activity services offered at truck stops and rest areas along Brazilian roads from March to August 2023 were used. The data were analyzed with simple frequency descriptive statistics. The sample consisted of 175 long-haul truck drivers. Out of these, 70.29% declared that the services of the truck stops and rest areas were charged; more than half (53.59%) of the professionals evaluated the rest service as "good" or "excellent"; the food services were "good" or "excellent" for 42.24% of the drivers. The spaces for physical activities were the worst evaluated as "bad" or "terrible" by 41.61%, followed by bathroom services (28.42%) and safety (34.24%). Rest and feeding services had better evaluations, while the services of bathroom, safety, and physical activity presented worse evaluations. Variables such as nationality, weekly working days, and marital status presented positive significance and influenced drivers' perceptions of the services offered at truck stops and rest areas. Drivers who were Brazilian and worked more than five days a week negatively evaluated the services of rest (p = 0.018), safety [0.020], physical activity (0.003), and bathrooms (0.020). In addition, the physical activity services were better evaluated by single drivers than married drivers. These findings suggest that the work conditions and nationality may influence LHTDs' perceptions of services and structures of truck stops and rest areas. These findings may reflect a lack of investments and support efforts to improve basic services such as personal hygiene, a safe environment, and physical exercises, which are fundamental to the health of the workers and aimed at reducing vulnerability and a sedentary lifestyle and meeting the basic human needs of LHTDs.

The Effect of Dietary Types on Gut Microbiota Composition and Development of Non-Communicable Diseases: A Narrative Review.

INTRODUCTION: The importance of diet in shaping the gut microbiota is well established and may help improve an individual's overall health. Many other factors, such as genetics, age, exercise, antibiotic therapy, or tobacco use, also play a role in influencing gut microbiota. AIM: This narrative review summarizes how three distinct dietary types (plant-based, Mediterranean, and Western) affect the composition of gut microbiota and the development of non-communicable diseases (NCDs). METHODS: A comprehensive literature search was conducted using the PubMed, Web of Science, and Scopus databases, focusing on the keywords "dietary pattern", "gut microbiota" and "dysbiosis". RESULTS: Both plant-based and Mediterranean diets have been shown to promote the production of beneficial bacterial metabolites, such as short-chain fatty acids (SCFAs), while simultaneously lowering concentrations of trimethylamine-N-oxide (TMAO), a molecule associated with negative health outcomes. Additionally, they have a positive impact on microbial diversity and therefore are generally considered healthy dietary types. On the other hand, the Western diet is a typical example of an unhealthy nutritional approach leading to an overgrowth of pathogenic bacteria, where TMAO levels rise and SCFA production drops due to gut dysbiosis. CONCLUSION: The current scientific literature consistently highlights the superiority of plant-based and Mediterranean dietary types over the Western diet in promoting gut health and preventing NCDs. Understanding the influence of diet on gut microbiota modulation may pave the way for novel therapeutic strategies.

Examining determinants of control of metabolic syndrome among older adults with NCDs receiving service at NCD Plus clinics: multilevel analysis.

BACKGROUND: Metabolic syndrome (MetS) in older adults with hypertension, diabetes, and hyperlipidemia increases the risks of cardiovascular diseases by 2.5 times and type 2 diabetes by five times. This study aimed to explain the multilevel relationships between health service system factors and individual-level factors influencing the control of MetS among older adults with NCDs receiving health care services at the NCD Plus clinics of hospitals in 1 year. METHODS: This cross-sectional analytical study employed a systematic sampling method to have two groups of samples from 4 regions of Thailand: (1) 600 older adults having at least one diagnosis of NCDs receiving services at NCD Plus clinics and (2) 12 nurses in charge of the NCD Plus clinics at the hospitals providing services to these patient samples. Data were analyzed using multilevel logistic regression analysis. RESULTS: 24% of older adults with NCDs can control MetS within one year. The MetS escalation from the initial assessment to 1-year follow-up varied according to the level of the hospitals. The transition from MetS to non-MetS status was rare in older adults with NCDs. Among health service system factors, complete screening for MetS influenced 1-year MetS control (95% CI [1.06, 2.92]). Older adults who were female and who had polypharmacy had a 66% (95% CI [0.22, 0.53]) and a 54% (95% CI [0.29 - 0.71]) reduction chance in MetS control. Older adults, who were ≥ 80 years old, labor-employed, healthy dietary patterns, and medication adherence increased chances of controlling MetS by 2.38 times (95% CI [1.12, 5.05]), 2.14 times (95% CI [1.03, 4.42]), 1.61 times (95% CI [1.06-2.46]), and 3.18 times (95% CI [1.51, 6.70]), respectively. CONCLUSIONS: NCDs Plus clinics that provide complete screening for MetS significantly enhance their effectiveness in reducing the proportion of older adults with MetS. In addition, the service should pay attention to older adults who are female, are retired, and take multiple medications to achieve MetS control better. The insights gained from such an analysis could be instrumental in pinpointing the resources necessary to bolster the efficacy of NCD Plus clinics.

Navigating delayed diagnoses, self-neglect, and lost livelihoods: a qualitative exploration of fisherfolk's health perspectives and management of non-communicable diseases in Kerala, India.

INTRODUCTION: Non-Communicable Diseases (NCDs) place a significant burden on India's healthcare system, accounting for approximately 62% of all deaths in the country in 2017. The southern Indian state - Kerala - has some of the highest rates of NCDs. Within the state, the fisherfolk community has a high prevalence of risk factors such as tobacco use and alcohol consumption. Working in the fisheries industry demands physical exertion, night shifts alongside extended periods of time at sea (for seafaring fisherfolk). Evidence is scant on how these conditions relate to the health-seeking experiences of fisherfolk, particularly in the context of NCDs. We conducted a qualitative study in two districts of Kerala to fill this gap. METHODS: In-depth individual and small group interviews- as per participant preference -  with male and female fishing community members living with NCDs were conducted between October 2022 and February 2023 in two districts of Kerala. Interviews were conducted to explore community members' experiences with health-seeking for NCDs. Transliterated English transcripts were coded using ATLAS.ti software and analysed using thematic analysis with inductive generation of codes, with indexing against Levesque, Harris, and Russell's 2013 access to healthcare framework. RESULTS: Thirty-three interviews with 42 participants were conducted. We found that NCDs were usually diagnosed late- either when admitted/consulted for other illnesses or when the symptoms became unbearable. Health-seeking patterns differed between seafaring and inland fishing subgroups, who were sampled from two districts in the state. Seafaring fisherfolk preferred public facilities for regular checkups and medicines while in-land fisherfolk relied on private facilities, although it was considered expensive. Ability to seek care was impacted by the working hours of the health centre which did not suit their working hours. Health constaints and related expenses also impacted their financial status and occupation, with some opting for less strenuous jobs. CONCLUSION: This study highlights the NCD-related health-seeking experiences of the fisherfolk community in Kerala, India. Fisherfolk reported self neglect, delayed diagnosis, cost and livelihood constraints owing to the onset of NCDs, even as dual practice and medicine access in the public sector were appreciated. Overall, larger studies and policymaking processes should consider in depth the experiences faced by particular economic groups like fisherfolk, who may face unique health and care-seeking challenges.

A comparative systematic review of risk factors, prevalence, and challenges contributing to non-communicable diseases in South Asia, Africa, and Caribbeans.

BACKGROUND: Non-communicable diseases (NCDs) are a global epidemic challenging global public health authorities while imposing a heavy burden on healthcare systems and economies. AIM: To explore and compare the prevalence of NCDs in South Asia, the Caribbean, and non-sub-Saharan Africa, aiming to identify both commonalities and differences contributing to the NCD epidemic in these areas while investigating potential recommendations addressing the NCD epidemic. METHOD: A comprehensive search of relevant literature was carried out to identify and appraise published articles systematically using the Cochrane Library, Ovid, Google Scholar, PubMed, Science Direct, and Web of Science search engines between 2010 and 2023. A total of 50 articles fell within the inclusion criteria. RESULTS: Numerous geographical variables, such as lifestyle factors, socio-economic issues, social awareness, and the calibre of the local healthcare system, influence both the prevalence and treatment of NCDs. The NCDs contributors in the Caribbean include physical inactivity, poor fruit and vegetable intake, a sedentary lifestyle, and smoking, among others. While for South Asia, these were: insufficient societal awareness of NCDs, poverty, urbanization, industrialization, and inadequate regulation implementation in South Asia. Malnutrition, inactivity, alcohol misuse, lack of medical care, and low budgets are responsible for increasing NCD cases in Africa. CONCLUSION: Premature mortality from NCDs can be avoided using efficient treatments that reduce risk factor exposure for individuals and populations. Proper planning, implementation, monitoring, training, and research on risk factors and challenges of NCDs would significantly combat the situation in these regions.