My weekly medical news blog for 7th February

There have been few takers for GP training places in Nanjing. The city's community health centres need to recruit 110 family doctors to fill their positions but have only had 49 applicants. Under new health ministry regulations, all doctors including GPs must have the 5+3 education and training (5 years undergraduate and 3 years postgraduate.) However, despite offering a masters degree and a one month placement with GPs in Taiwan, most medical graduates have given the GP training scheme the cold shoulder. The reason is the low status and poor pay of 'community doctors'. After eight years training, GPs can expect to earn only about 80,000 yuan (US$13,000) a year, which is much lower than hospital-based specialists earn. Also there is no chance of promotion or career progression and GPs are expected to move around many clinics in suburbs and villages. Health educators say the Chinese government needs to put more emphasis and resources into primary care if it is to develop a healthcare gatekeeper system similar to those used successfully in developed countries.

Most of the 'research' published by China's doctors is rubbish and there's a simple reason for this - the publish-for-promotion system. To gain promotion (and often just to stay in the job) all China's doctors have to meet a certain quota of  papers published in medical journals. The problem is that most of China's doctors are way too busy treating patients to be doing research and writing up papers. Many are simply not interested. The result is a thriving industry in academic fakery and plagiarism. It is common knowledge that doctors hire 'publishing agents' and ghostwriters to source the articles that will be published under their name. Ironically, many of the articles are written by medical students, and so there is an inverted system whereby the most knowledgeable and experienced clinicians are publishing articles written by the least knowledgeable. The going rate is about 3000-4000 yuan for a good paper - payment on publication, of course. Experts say the system has become a wasteful farce, and they are calling for reform of the one-size-fits-all quote system, to divide doctors into three categories: 'craftsmen' (no research, just treating patients), physicians (some research) and medical scientists (more  research, fewer patients).

The government says it expects to see a dramatic increase in uptake of private medical insurance before 2020, with new policies encouraging Chinese citizens to take out private cover. Ma Xiaowei, deputy head of the health ministry, the National Health and Family Planning Committee, told a news conference this week that the central and provincial government would "encourage the development of various types of commercial insurance to increase people's ability to deal with risks posed by major diseases." He said private cover was needed to help fund demand for health services, with the number of people over 60 already exceeding 200 million. However Mr Ma didn't explain how people will be enticed to take out private health insurance given that there are currently virtually no private doctors or hospitals and very few services or benefits from having insurance.

Underpaid, overworked and under fire: that's the life of an emergency medicine specialist in Guizhou province, according to a Sina article this week. In China, emergency doctors accompany ambulances and are often first on the scene of trouble, even before police. One doctor said he often had to jump in and stop bleeding in stabbing victims while people were still fighting around him. Another said emergcny doctors were often faced with physical challenges such as getting critically ill patients down stairs of apartment blocks with no lifts. Emergency doctors said they worked 24 hour shifts then had a day off during which they mostly slept, and there was no time for leisure, holidays or study. The stress of daily life as an emergency doctor meant there were high rates of burnout - and doctors were considered grizzled veterans if they lasted three years, they said.

In clinical news, new research shows that older Chinese are consuming more calories - and eating more unhealthy food - than their counterparts of the previous generation. A study from nine provinces found that the average daily energy intake had increased among older Chinese adults from 1379 total kilocalories in 1991 to 1463 kilocalories in 2009. The increases had come from greater consumption of high fat and high carbohydrate foods such as plant oil, wheat buns, and wheat noodles.

Chinese are also consuming more polluted air and it is killing them as much as smoking. A study carried out by the School of Public Health in Peking University found that there were
257,000 premature deaths related to PM2.5 pollution in 31 major Chinese cities. This made air pollution a major killer equivalent to smoking. Conditions such as lung cancer and stroke triggered by air pollution killed about 18,000 people in Beijing alone in 2013, the researchers said.

And finally, a study from Shanghai as shown that the number of cervical cancer diagnoses in the city has increased six fold in the last decade. Data from 13,518 women with gynaecological cancers  from 2003 to 2013 showed that the number of women with diagnosed gynaecological cancers increased by almost sixfold with the increase largely due to the increase of women with newly diagnosed cervical cancer. The study also showed that the age of diagnosis of cervical cancer had increased.

What the Chinese can learn from Tibetans about hypertension

by Michael Woodhead
I've always wondered why Tibetans could be so healthy when they seem to subsist on a diet composed of dairy and meat, perhaps with the odd potato thrown on the fire. 

One of the staples of the Tibetan diet is tsampa - the butter 'tea' which is more like a salty yak butter tea-milkshake. This is not your EasyWay shake - tsampa is made with barley and is often accompanied by a glob of fermented yak milk sometimes known as kurut - similar to the products seen in Xinjiang.

Now it seems there is a hidden healthy component of Tibetan dairy products that has powerful antihypertensive properties, as strong as the drugs prescribed by western cardiologists. The blood pressure lowering effects come from the fermented milks produced by 259 Lactobacillus helveticus - a kind of probiotic ACE inhibitor if you like. Something in the Lactobacillus has potent effects on Angiotensin Converting Enzyme (ACE), the same system that is the target of modern antihypertensives such as enalapril.

In a recent study conducted by dairy technologists at the Inner Mongolia Agricultural University, Huhho, the fermented milk product was found to contain antihypertensive peptides that lower blood pressure by about 12 mmHg for six to 12 hours. That is fairly impressive BP lowering - and would be useful in a typical hypertensive patient with a systolic BP of 140/95mmHg who wanted to get to a target of 120mmHg.

As well as keeping Tibetans healthy, Dr Chen Yongfu and colleagues say the newly-identified probiotic/peptide may have potential as "a valuable resource for future development of functional foods for hypertension management."

Daqing strikes gold with diabetes prevention study

by Michael Woodhead
The oil town of Daqing in north China is now becoming famous for something quite different - preventing diabetes. 
Results from a 23-year study conducted in the city have show that people at risk of diabetes can avoid progressing to the disease and almost halve their risk of death by adopting a healthier diet and doing more exercise.
The findings from the study, published in the Lancet Diabetes & Endocrinology this week have been hailed as a breakthough by international experts because they answer many of the difficult questions about how diabetes may be prevented and its harms minimised.
The study started in 1986, when 577 people with impaired glucose tolerance were assigned to either an intervention group that received advice on diet and/or exercise, or a control group. The lifestyle coaching sessions lasted for six years during which participants received regular encouragement to eat more vegetables and consume less sugar and alcohol, and encouraged them to do more physical activity in their spare time.
Now after more than 20 years of follow up, researchers have found that the people who received the lifestyle advice had a cardiovascular death rate of 1% compared to 20% in the control group. The overall death rate was 28% in the lifestyle group compared to 38% in the control group. Rates of progression to diabetes were 73% in the lifestyle group and 90% in the control group.
"These findings emphasise the long-term clinical benefits of lifestyle intervention for patients with impaired glucose tolerance and provide further justification for adoption of lifestyle interventions as public health measures to control the consequences of diabetes," said lead study author Professor Li Guangwei of the Department of Endocrinology at the China-Japan Friendship Hospital, Beijing.
Commenting on the findings, Professor Nicholas Wareham of Cambridge University said the study was a "real breakthrough, showing that lifestyle intervention can reduce the risk of long-term cardiovascular consequences of diabetes." He said the study showed that lifestyle change could be achieved in the real world and it was notable that the effects were particularly strong in women.

Medical news - seven China links

1. With more than 10,000 new cases of HIV a year, Yunnan is to fund more NGO anti-HIV programs and improve healthcare for people with the infection.

2. New regulations on genome sequencing are to stop clinics ripping off consumers by offering the sequencing as part of routine health checks or to help predict children’s potential abilities, officials say.

3. Malnutrition is still a major problem in some parts of rural China, with one in every five children under the age of five years in poor areas needing better nutrition. Local governments have been set a benchmark of 29 kg per capita meat consumption standard to benefit children in underdeveloped region.

4. Pilot schemes have been set up in 27 provinces to allow rural migrants to claim medical insurance benefits away from their home town.

5. About 13 million deaths from smoking-related illness could be avoided if China adopted WHO recommendations on tobacco control, a paper in the BMJ says.

6. Adverse effects from drugs - and especially antibiotics - are a major health burden for hospitals in China and also cost thousands a of yuan a year for hospitals and patients alike in extra care costs, a study has suggested.

7. Only 9% of boys and 2% of girls in China get the minimum amount of physical activity per week to maintain health, a study carried out in 11 cities has found.

Clinical news in brief - from the journals

In 'grassroots' hospitals, knowledge about Parkinson's disease - its diagnosis and management - is very limited for both neurologists and patients, a study from the West China Hospital in Chengdu has shown. Neurologists lacked knowledge of non-motor symptoms, differential diagnosis, therapeutic strategy and appropriate indications of surgical treatment, although they were familiar with the motor symptoms of the disease.

Adenoviruses cause 10% of cases where children are hospitalised for severe diarrhoea in China, according to a study from the Capital Institute of Pediatrics, Beijing.

More than 95% of people in Jiangsu have inadequate levels of riboflavin in their diet, putting them at risk of anaemia, a study has shown.

High levels of arsenic in seafood - and especially shellfish - pose a risk to human health, researchers from Shandong have warned.

People with epilepsy who have been seizure free for at least two years may be able to come off their anti-epilepsy medication, neurologists in Chengdu has shown. In a study of 162 patents with epilepsy who slowly tapered off their medication, 23% had a recurrent seizure and had to re-commence medication.

Ovarian cancer is relatively uncommon in China and rates are in decline, a review by the Henan Cancer Research and Control Office has concluded.

News in brief: clinical studies from China

Measles is now rare in Guangzhou thanks to vaccination, but complete eradication will require vaccination of transient populations who now account for more than half of cases.

People who have a heart attack in China delay going to hospital for more than two hours, often because they don’t recognise the symptoms or their importance.

Chinese people consume dangerously high amounts of salt, with a Yantai study showing that 97% of men and 87% of women had intakes of over 6 g salt per day (mostly from added salt and soy sauce). Salt intake was related to high systolic blood pressure.

More than one in four new mothers in Guangzhou experience post-partum depression.

Compulsory routine infant vaccination with pneumococcal conjugate heptavalent vaccine would reduce pneumococcal disease in China by at least 32%, would prevent 2,682 deaths in the first five years of life and would save $1,190 million.

In rural China epilepsy goes untreated or undertreated in two out of three people with the condition, a Sichuan study has found. One third of people with epilepsy did not know about the disease and had not sought medical help.

The cultural pressure for gay men in China to marry means that their wives face a high risk of HIV and syphilis, researchers from Ningbo say. They found that only one in four gay men always used condoms with their wives, which explained HIV rates of more than 8% in women married to gay men.

Low vitamin A levels are linked to eye cysts (chalazia) in south west China

Weather has an important influence on measles transmission in China, with infection more likely after cold spells and during dry weather.

China's medical news for Friday 31 January

Breast milk contains high levels of DDT
Breastfeeding mothers in Zhejiang have high levels of DDT in their milk, a study has shown. Researchers said the high levels of DDT found in breast milk were in excess of safe limits and showed that human milk was "grossly polluted". The DDT was thoght to come from seafood in the diet, the researchers said in the journal Environment International.

Shanghai obesity myth dispelled
Shanghai researchers have dispelled the concept of 'metabolically healthy obese'. In a study of more than 211,000 people over 40 i 25 areas of China they showed that  obesity was a risk factor for  CHD regardless of the presence or absence of insulin resistance. The findings are published in the International Journal of Cardiology.

Zinc levels linked to naughty children
Low zinc levels have been linked to behavioural problems in pre-school children in China. A study conducted in 1314 children in Jintan, Jiangsu found that low zinc levels were significantly associated with increased reports of total behavior problems. Living in the suburbs was associated with increased internalizing problems, while higher mother’s education and being female were associated with decreased externalizing problems, the study in the journal Nutrients found.

N95 face masks prove effective

A study of the effectiveness of N95 masks in Beijing has found that they are protective against bacterial colonization, co-colonization and viral-bacterial co-infection. The clinical trial of 1441 hospital staff found the rate of bacterial colonization was 2.8% with N95 mask users, 5.3% in medical mask users  and 7.5% in staff who did not wear any mask. Co-infections of bacteria and/or a virus  occurred in up to 3.7% of healthcare workers and were significantly lower in N95 wearers, the study in Preventive Medicine showed. (NB: See our earlier story that found N95 masks were a poor fit for Chinese faces).

Medicine costs and hospitals

The Economist has an article explaining why China's hospitals are dependent on revenue from drug sales for their financial viability. The magazine says efforts to reduce corruption will be difficult until the system is reformed, as hospital derive 40% of income from commissions on medicines and medical products.

China has psychotherapy boom

Mental disorders have traditionally been a taboo subject in China, but SBS reports that a reality television show Psychological Sessions has been captivating audiences across China. And a researcher says there is now a 'psychotherapy-boom' in China as people have become aware of modern-day stresses and the need for treatment. 

Women don't get a fair go in health

Women face medical discrimination in China as they appear to have lower rates of treatment than men, a study suggests. Published in the International Journal for Equity in Health, the study finds that women have lower rates of hospital admission than men for the same conditions. Women also have lower rates of investigations and shorter hospital stays compared to their male equivalents.

Beijing women deficient in vitamin D during pregnancy

Pregnant women in Beijing are deficient in vitamin D researcher have found. A study of 125 pregnant women found a 97% prevalence of vitamin D deficiency (25(OH)D < 50 nmol/L) and almost half of women were severely vitamin D deficiency (25(OH)D < 25 nmol/L). Duration of sun exposure and the use of multivitamin were the most important determinants for vitamin D status, according to the report in PLOS One.

China medical news roundup for Thursday 14 November

Beijing cardiologist uses microblog to educate a wider audience

On the walls of the inpatient wards of Beijing Anzhen Hospital, a large sign reads, "Please follow Yu Zhenqiu's micro blog for hypertension intervention".

Yu, the director of the hypertension department, said the micro blog helps him reach as many sufferers of high blood pressure as possible. Within his working hours, he can see no more than 30 patients even if he skips lunch.

"For the great majority who cannot see top specialty doctors like me at the country's large key hospitals, micro blogs might offer help."

His frequent postings on high blood pressure prevention and intervention tips, and answers to frequently asked questions, have brought Yu about 70,000 followers on Sina Weibo, a popular micro-blogging website.

Apart from information on free-hypertension consultation sessions, he also replies to questions online.

"Many of my postings have been forwarded thousands of times, a result that could never be achieved by treating patients in the hospital," he said.

Writing posts is now a daily routine for him, such as washing his face and brushing his teeth, he said.

Yu, who is also deputy director of the China Hypertension Association, used traditional media first to share prevention and treatment tips and educational items about the disease, before moving online.

Full article at: China Daily

Chinese parents won't take sick kids to small hospitals

With a shortage of pediatricians and inadequate medical facilities, bringing children to hospital can cause a lot of stress to parents. Some experts have suggested a change in parents' attitude and adoption of an alternative medical model. Liu Zhihua reports.

There is a shortage of at least 200,000 pediatricians in China currently, according to K. K. Cheng, a professor with University of Birmingham, who specializes in epidemiology and the development of primary care in China.

Yang Dan, a Chongqing resident and mother to a 3-year-old boy says she detests taking her child to the hospital.

The air circulation is poor. The area is noisy. It is so overcrowded that parents have to hold their children in their arms for intravenous infusion procedures. There have been cases of parents losing their children in the disorganized environment.

Yet sending their children to small hospitals is out of the question, because they cannot provide quality healthcare, Yang believes. She says once her son was misdiagnosed even in the largest hospital in Ya'an, a medium-size city in Sichuan province.

With the disparity in healthcare quality between rural and urban regions, between a top-level hospital and a less-privileged one, most Chinese parents share the belief that small hospitals are incompetent.

Read more at China Daily

China lags on preventive health, says WHO

China should do more to curb a rise in non-communicable diseases like heart disease and diabetes that have long been neglected and now pose a risk to its economy, global health experts warned.

Non-communicable diseases challenge China’s economic development and cause a burden on society, said Bernhard Schwartländer, the World Health Organization’s representative in China, in a press briefing on Tuesday. “The cost of inaction, of doing nothing—in lives lost and social and economic prosperity foregone—is too great a price to pay,” he said.

He was joined by representatives of China’s National Health and Family Planning Commission and China’s Centers for Disease Control and Prevention.

Dr. Schwartländer said that high rates of smoking, lack of exercise and unhealthy diets have contributed to diseases. He said that the Chinese government should adopt policies to address problems, which have been overlooked and underfunded.

By 2015, the burden of death and health complications related to non-communicable disease will have cost $500 billion in the last decade, Dr. Schwartlander said. Reducing mortality only by addressing cardiovascular disease, reducing rates 1% per year in by 2040, would generate $10.7 trillion, he said.

Health care was largely left out of a reform agenda Chinese leaders revealed on Tuesday, though it briefly mentioned improving people’s welfare and strengthening reform of the medical and health system. China launched in 2009 an overhaul of its health-care system, establishing a universal insurance system to provide citizens more access to medical care.

China is struggling to deal with a population that is urbanizing, aging and is afflicted with chronic disease. Migration of millions of Chinese citizens to big cities from rural regions has spurred use of cigarettes, higher alcohol intake and increasingly sedentary lifestyles—all habits that lend to illness.

Now China is home to the world’s largest diabetes population, with the prevalence of 11.6% of the population-surpassing Russia’s population, said Li Guangwei, a professor at the Chinese Academy of Medical Sciences. Chronic disease is the cause of 85% of deaths in China, according to China’s Ministry of Health. By comparison, the U.S. Centers for Disease Control and Prevention says the rate is 70 per 100 in the U.S., while the World Health Organization says they represent 63% of deaths world-wide.

Funding remains a major issue, experts said. China’s health spending as a percent of GDP totaled 2.3% in 2011, compared to U.S. spending of 9.7%, according to the most recent data available from the World Bank.

Community clinics are overrun with patients and lack resources needed to address health problems, said Wang Bin, the deputy director the Disease Control and Prevention department of China’s National Health and Family Planning Commission.

Tobacco control remains underfunded, said Jiang Yuan, deputy director of the Tobacco Control Office of China’s CDC. The government allocated only 20 million yuan (about $3.3 million) last year for tobacco control, Ms. Jiang said.

Dr. Schwartländer said it isn’t likely that the China will reach the target set for it by the WHO to cut smoking rates in China by at least 30% by 2025. Currently 28% of people older than 15—301 million people—are smokers in China and smoking-related sickness kills more than one million Chinese citizens each year, according to WHO data. That compares to 43.8 million smokers in the U.S., according to the U.S. Centers for Disease Control and Prevention.

Experts said that the government should not shoulder all the responsibilities to improve health conditions and that citizens should adopt healthier lifestyles by eating less salt, exercising more and cutting bad habits like smoking and drinking . “People are the owners of their own health,” said Dr. Wang, adding, “We’re at an important window in China.”

Source: WSJ

MSG may protect against diabetes: Nanjing study

A Jiangsu nutrition study has made the intriguing finding that MSG intake is inversely related to risk of hyperglycaemia.

Researchers from the Jiangsu Provincial Center for Disease Control and Prevention in Nanjing conducted a prospective dietary study of 1056 healthy adults from 2002 to 2007. Fasting blood samples were collected at baseline and follow up. Hyperglycemia was defined as fasting plasma glucose >5.6 mmol/l.

During the follow-up they identified 125 cases of hyperglycemia and found that people with the highest intakes of MSG had a lower risk of hyperglycemia. People with a high MSG intake, had only one third the risk of hyperglycemia compared with people with a low intake of MSG, they found. There was a linear inverse association between MSG intake and change in blood glucose.

The researchers noted that MSG stimulates insulin secretion by acting on glutamate receptors and is especially likely to decrease the risk of hyperglycemia in overweight-related insulin resistance.

“However, based on this single study we do not recommend people increase MSG intake in order to prevent diabetes,” they commented.

Read the full study at: Clinical Nutrition

Anhui man on trial for urologist stabbing

An Anhui Province man has been accused of stabbing a doctor at a Songjiang district hospital that he believed had cheated him, district prosecutors said Tuesday.
The suspect, surnamed Huang, visited a military-run hospital in the district in 2012 to see a urologist, according to a press release from the Songjiang District People's Prosecutor's Office. The doctor found a cyst and advised Huang that he would need to have surgery to remove it or face potential health problems in the future.
Huang agreed, though reluctantly. The surgery cost him more than 20,000 yuan ($3,283), including the four-day hospital stay afterward. Several months later, Huang had recovered from the surgery, but still doubted whether it had been necessary, prosecutors said. He suspected that the urologist only suggested the surgery to help the hospital make money.
In April, Huang returned to the hospital seeking treatment for stomach pain. Another doctor prescribed him medication, but it failed to relieve his discomfort after more than 10 days. When Huang went back to complain, the doctor said that it might take more time for the medication to take effect.
Huang believed that the doctor was lying to him and only wanted his money, prosecutors said. He complained to the local health authority and to police, but nothing came of it.
In May, Huang returned to the hospital with a knife and stabbed the urologist, prosecutors said. He then went looking for the other doctor who treated him, but was stopped by hospital security guards. The urologist suffered minor injuries.
Huang confessed to stabbing the doctor and admitted that he had been unhappy with the hospital's care. 

Source: Global Times

Iron and vitamin supplements not needed to improve pregnancy outcomes: Chinese study

Prenatal iron–folic acid and other micronutrient supplements provide no extra benefit to Chinese women in perinatal mortality or other infant outcomes beyond any benefit conferred by folic acid alone , a major study has shown.
In a randomized double-blind controlled trial, 18 775 nulliparous pregnant women with mild or no anemia were enrolled from five counties of northern China from May 2006 through April 2009. Women were randomly assigned to daily folic acid (400 μg) (control), folic acid–iron (30 mg), or folic acid, iron, and 13 additional vitamins and minerals provided before 20 weeks gestation to delivery.  Compared with daily prenatal folic acid, supplementation with iron–folic acid with or without other micronutrients did not affect the rate of perinatal mortality or other adverse maternal and infant outcomes except  for third-trimester maternal anemia.
Source: JAMA Internal Medicine.

China clinical news in brief

Infant gastro infections may trigger convulsions

Benign convulsions may occur in infants with mild gastroenteritis, Chinese paediatricians have shown.
Dr Wang Yunfeng of the Department of Pediatrics at the Sino-Japan Friendship Hospital, Beijing says that benign convulsions are now recognized as a distinct clinical entity in many countries, but its occurrence in China has not yet been widely recognized by Chinese pediatricians.
In a retrospective study  in 48 infant patients with benign convulsions they found that the typical age of onset of gastroenteritis was between 13 months and 24 months. The episodes of convulsions occurred at a distinct autumn/winter peak, and the seizures mostly occurred within the first five days of gastroenteritis, especially within the first three days, peaking on day 2 (39.58%).
They found that in 80% of cases the infants had clustered seizures in their episodes. Most episodes were symmetric, generalized tonic-clonic  and brief. The seizures were induced by pain and/or crying in 40% of infants. Stool culture was positive for rotavirus in 54% of the patients. Almost half the infants still had clustered seizures after the administration of a single anticonvulsant drug. The seizures persisted even after the administration of two combined anticonvulsants in a quarter of episodes. All patients exhibited normal psychomotor development.
"Benign convulsions with mild gastroenteritis are not rare in China, and rotavirus infection is a major cause," the researchers conclude.
Source: World Journal of Paediatrics

MSG linked to snoring and sleep disordered breathing

People who consume MSG with their food are more prone to snoring and sleep disordered breathing, researchers from Nanjing have shown.
An analysis of data from 1227 Chinese people who participated in the Jiangsu Nutrition Study found that MSG intake was positively associated with snoring and a high probability of sleep disordered breathing such as sleep apnoea.
However, the association was not seen in in overweight people, according to Dr Shi Zumin and co-researchers at the Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Centrr for Disease Control and Prevention, Nanjing.
People who had higher intakes were twice as likely to snore and three times more likely to have sleep apnoea, the study showed..
Source: Nutrition Journal

One in three people with diabetes have chronic kidney disease

Almost one in three Chinese people with type 2 diabetes have chronic kidney disease and albuminuria, a Nanjing study has found.
Dr Lou Qing-Lin and co-researchers from the Diabetes Care and Research Centre at the Jiangsu Province Institute of Geriatrics conducted a study of more than 15000 patients with type 2 diabetes in Nanjing between January 2008 and December 2009.
They found that the frequency of CKD and albuminuria was 31% and 29%, respectively.
Hypertension, anaemia and duration of diabetes were significantly associated with CKD.
"In conclusion, chronic kidney disease is common in the urban Nanjing Chinese with type 2 diabetes. Strategies to prevent or delay progression of kidney disease in diabetes should be carried out at the early disease course of type 2 diabetes," they conclude.
Source: Diabetes and Metabolism Journal

Clinical news in brief

Malnutrition and anaemia are rife in Shaanxi infants

One in three infants in impoverished rural Shaanxi have anaemic and malnutrition, a study has found
Researchers from the Maternal and Child Health Centre of the First Affiliated Hospital of Medical
College in Xi’an sampled 336 infants in 28 rural villages from two counties of Shaanxi province. They found that 35% of infants in suffered from anemia, 32% had malnutrition, stunting or
wasting. Anemia was linked with malnutrition, while low birth weight, having more siblings, less maternal education, low family income, crowded living conditions, and inappropriate complementary food introduction significantly increased the risk for infant anemia. Serum concentrations of iron, zinc, and retinol (vitamin A) were significantly lower in anemic infants, they study showed.
"Health education focusing on feeding practices and nutrition education could be a practical strategy for preventing anemia and malnutrition in young children.," the researchers suggest.
Source: BMC Public Health

Vaccine against tooth decay

Wuhan researchers have developed a vaccine that could make tooth decay - and visits to the dentist - a thing of the past.
The researchers from Hubei have shown that an anti-caries DNA vaccine induced salivary secretory immunoglobulin A (S-IgA) antibodies to Streptococcus mutans (S. mutans) the main causative agent for dental caries.
By stimulating the production of the antibodies, the vaccine  was effective in preventing adhesion of the S. mutans bacteria to a tooth model.
"These results demonstrate that the anti-caries DNA vaccine induces the production of specific S-IgA antibodies that may prevent dental caries by inhibiting the initial adherence of S. mutans onto tooth surfaces, thereby reducing the accumulation of S. mutans on the acquired pellicles," they say.
Read more: Acta Pharmacologica Sinica.

Tamiflu resistance emerges in China

Two new mutant forms of influenza virus detected in China are resistant to neuraminidase inhibitors drugs such as Tamiflu that are the only option for treatment.
Researchers from the National Institute for Viral Disease Control and Prevention at the Chinese Centre for Disease Control and Prevention, Beijing, tested more than 600 influenza B virus samples collected in 2010 and 2011 for susceptibility to oseltamivir and zanamivir. They found four influenza B virus samples showed reduced susceptibilities to oseltamivir, but not zanamivir, while another showed resistance to both.They say that "[antiviral] drug resistance is a public health concern" and that "this report underlies the importance of continued influenza antiviral susceptibility surveillance globally, even in countries where the use of neuraminidase inhibitors  has been low or non-existent."
Read more: Antiviral Research

Salt substitution reduces hypertension in Chinese people

Blood pressure was lowered by 4mm after replacing some sodium chloride with potassium chloride

by Michael Woodhead
Replacing regular salt with a potassium chloride-based  alternative may be an effective additional way to lower blood pressure for Chinese hypertensive patients, a study has shown.
Professor Zhou Beufan and colleagues from Beijing assessed the potential efficacy of replacing sodium chloride with potassium chloride for preventing hypertension in patients with hypertension and also in normotensive family member controls.
They conducted a double-blind, randomized controlled trial among 200 families in rural China to establish the two-year effects of a reduced-sodium, high-potassium salt substitute (65% sodium chloride, 25% potassium chloride, 10% magnesium sulfate) compared with normal salt (100% sodium chloride) on blood pressure.
Of the 372 people who completed the study, the mean overall difference in blood pressure between the two groups at the 24-month follow-up was 2 mm Hg for systolic BP and  and 2 mm Hg for diastolic BP. For the people with hypertension, there was a 4mm Hg overall decrease in systolic blood pressure, but diastolic blood pressure was not affected by salt use in the hypertensive group.
The researchers conclude that salt substitution lowers systolic blood pressure in hypertensive patients and lowers both systolic and diastolic blood pressure in normotensive controls.
"Salt substitution, therefore, may be an effective adjuvant therapy for hypertensive patients and [has] potential efficacy in preventing hypertension in normotensive individuals," they say.
Source: Journal of Human Hypertension

Carcinogens in Shenzhen food supply pose cancer risk

High levels of carcinogenic aromatic hydrocarbons have been found in vegetable, pork and rice samples collected from Shenzhen. The cancer risk from exposure to polycyclic and halogenated aromatic hydrocarbons was estimated to be between "serious" and "acceptable", with children facing the highest cancer risk, followed by adolescents, seniors and adults.
Read more: Science of the Total Environment

No link between MSG and asthma, Nanjing study shows

Large study found no link between MSG consumption and asthma

by Michael Woodhead
The first major population study to look at the possible role of MSG and asthma has found no link between the consumption of monosodium glutamate and asthma rates.
Dr Shi Zumin, a researcher from the Department of Nutrition and Foodborne Disease Prevention at Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, undertook a study of MSG and asthma because emerging evidence shows that diet is related to asthma.
In a study of data from 1486 Chinese men and women who participated in the Jiangsu Nutrition Study, MSG intake and dietary patterns were assessed in 2002. Information on asthma history was collected during followed-up in 2007.
Of the study population, 1.4% reported ever having asthma. MSG intake was not positively associated with asthma. However, there was a significant positive association between ‘traditional’ (high loadings on rice, wheat flour, and vegetable) food pattern and asthma. No link with asthma was seen with a diet rich in meat and alcohol, nor for a 'sweet tooth' diet high in cake, milk, and yoghurt, or a ‘vegetable rich’ diet high in whole grain, fruit, and vegetables.
Dr Shi says a MSG was first reported  to be linked to asthma attacks in 1981 after a person developed asthma after ingesting a meal in a Chinese restaurant. However, small clinical trials on MSG and asthma have yielded inconsistent results, with some suggesting that MSG intake was a trigger factor for asthma, while others showing no  link.
He notes that the prevalence of asthma in the Chinese population is lower than Western populations, and the prevalence of asthma (1.4%) in the study was consistent with that of other studies
"In our [study], even though the mean MSG intake is high compared with many developed countries, we did not observe a significant increased risk of asthma," he concludes.
Source: PLOS One

Rice is worse for diabetes in Chinese than in Europeans

Glycaemic response to white rice is 60% higher in Chinese compared to Europeans

by Michael Woodhead
Researchers say Chinese people at high risk of diabetes should find alternatives to white rice, because glycaemic responses after eating rice are appreciably greater in Chinese compared with Europeans.
Writing in the journal Diabetic Medicine, they say diabetes rates are especially high in China, and risk of Type 2 diabetes increases with high intakes of white rice, a staple food of Chinese people.
In a study of  32 Chinese and 31 Europeans, the researchers tested blood sugar responses  following ingestion of glucose and jasmine, basmati, brown, Doongara and parboiled rice.
The glycaemic response was over 60% greater for the five rice varieties  and 39% greater for glucose amongst Chinese compared with Europeans. The glycaemic index (GI) was approximately 20% greater for rice varieties other than basmati rice.
"These findings have considerable potential clinical significance given the global epidemic of Type 2 diabetes and the especially high rates in Asian countries such as China where rice is a staple food, The researchers say.
"In view of the extent to which white rice contributes to the overall glycaemic load of the diet and the data which suggest a relationship between high
intakes of white rice and risk of Type 2 diabetes [5], it is conceivable that encouraging the use of rice with the lowest glycaemic index may reduce the risk of Type 2 diabetes.
"Alternatively, partial replacement of rice with culturally acceptable lower glycaemic index foods such as pulses might be a useful means of lowering postprandial glycaemia. The same dietary modifications may be appropriate in the nutritional management of people who have already developed diabetes."
Read more: Diabetic Medicine

Hypertension risk for adults born during China's great famine

Adults born during the 1959-61 famine are likely to have growth retardation and hypertension

by Michael Woodhead
Babies born during the great Chinese famine of 1959-61 have a higher risk of hypertension and short stature in adulthood, research shows.
The 1959-1961 Chinese Great Famine  triggered by the Great Leap Forward appears to have had an adverse event especially  fetal development in the first trimester of pregnancy, according to researchers from the Department of Preventive Medicine, School of Public Health, Guangzhou Medical University.
They conducted a retrospective study of 12,065 adults aged between 46-53 who were born between 1957-1964 in  Guangdong province, China.
Their findings showed that the risk of hypertension was 1.4-fold higher in babies whose mothers were exposed to famine conditions during the first trimester of pregnancy, and 1.83-fold higher in babies experienced famine during infancy. People who experienced famine during infancy also had an increased risk of short stature, but not of obesity.
The researchers note that the 1959–1961 Chinese Great Famine, caused by a sharp drop in crop production and the “Great Leap Forward” policies, was the largest in human history, lasting approximately three years and resulting in about 30 million deaths and about the same number of lost or postponed births.
"Our study on the effects of early life exposure to the Chinese Great Famine strongly suggests a critical role for changes in exposure to famine during the fetal development period and from prenatal to postnatal life in developmental “programming” cardiovascular risk. Good infant nutrition appears to be beneficial whatever the fetus experienced in utero," the researchers conclude
Read more: PLOS One

Children develop goitre as iodine supplementation goes too far

In some area, 8% of children have goitre from excessive iodine

by Michael Woodhead
In some parts of China almost one in ten children have goitre (enlarged thyroid glands) due to excess levels of iodine added to drinking water and salt, new research shows.
Iodine supplementation of salt was introduced in China in the 1990s to combat iodine deficiency which has been a long term problem i some areas.
However, the supplementation may have gone too far say researchers from Tongji University, Shanghai. They examined iodine levels in almost 1600 schoolchildren 8 to 10 y old from the 16 counties of China. They found that in each area, the median urinary iodine of schoolchildren was nearly or above 200 μg/L, which confirmed the effectiveness of the iodisation strategy.
However, in areas with an iodine content higher than 150 μg/L in the drinking water, schoolchildren had more than adequate or excessive iodine intake, which was associated with an 8% prevalence of goitre.
"Therefore, it is important to adjust the strategy of universal salt iodisation control in China," the researchers say.
Read more: Nutrition

Vitamin B deficiency linked to depression in Chinese people

Thiamine deficiency linked to three-fold higher risk of depression

by Michael Woodhead 

People with low levels of the vitamin B component thiamine have a three-fold higher risk of depression, Shanghai researchers have shown.
According to researchers from the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences at the Shanghai Institutes for Biological Sciences, thiamine has been hypothesized to play an important role in mental health; however, few studies have investigated the association between thiamine nutritional status and depression in the Chinese population.
Therefore they conducted a trial to examine levels of thiamine and its phosphate esters [thiamine monophosphate (TMP) and thiamine diphosphate (TDP)] in erythrocytes of 1587 Chinese men and women.
They found that just over 11% of people had depressive symptoms, and that lower concentrations of all three thiamine biomarkers were associated with a higher prevalence of depressive symptoms.  People with the lowest thiamine levels had a 3-3.5 time higher risk of depressive symptoms compared to people with higher levels of thiamine.
"In conclusion, poorer thiamine nutritional status and higher odds of depressive symptoms were associated among older Chinese adults. This finding should be further investigated in prospective or interventional studies," the researchers say.
Read more: Journal of Nutrition

Beijing mums and babies have severe vitamin D deficiency

More than 50% of pregnant women had vitamin D deficiency

by Michael Woodhead
Pregnant women living in Beijing are at high risk of vitamin D deficiency, and many babies are born underweight because their mothers lack of the vitamin, Chinese researchers have shown
Clinicians from the Department of Pathology and Experimental Medicine at the 306 Hospital of PLA, Beijing measured vitamin D levels [25-hydroxyvitamin D (25(OH)D] in seventy pregnant woman and also analysed the health of their babies
They found severe vitamin D deficiency  (levels below 25 nmol/l) in 55 % of mothers and 47 % of newborns. Neither mothers nor newborns had vitamin D concentrations that reached the normal level (over 75 nmol/l). In addition the levels of vitamin D in mothers was positively correlated with that in the unborn (i.e. in placental cord blood). The research show that newborns of mothers with severe vitamin D deficiency had lower birth length and birth weight. The baby's head circumference and birth weight were lower in vitamin D-deficient newborns.
"[Our] study indicates that pregnant women and neonates residing in Beijing are at high risk of vitamin D deficiency.  [Vitamin D] concentrations are dependently related to maternal 25(OH)D levels. Maternal and neonatal vitamin D status influences newborn size," the researchers conclude.
Read more: Public Health Nutrition