Global Guidelines

Indian doctors oppose new diabetes norms (The Times of India:20180320)

https://timesofindia.indiatimes.com/city/mumbai/indian-docs-oppose-new-diabetes-

normsnew-diabetes-norms-not-meant-for-indians/articleshow/63372962.cms

MUMBAI: A new set of global guidelines on managing diabetes that aim to replace those

followed for over three decades has stirred up a row within the medical community.

Doctors in India feel the norms, which recommend relaxing blood sugar targets, will not only

lead to serious complications in diabetics but also confusion in treatment protocol. They

advise that these should be ignored for Indians.

The controversial norm relates to relaxing the long-term blood sugar target, hemoglobin A1C

(HbA1c) which, via a blood test, gives an estimate of a persons blood sugar level average

over the past few months. Generally, an HbA1c of 6.5% indicates diabetes.

There were over 72 million cases of diabetes in India in 2017, according to International

Diabetes Federation.

Haven't been to Mainland China in Chandigarh yet?

American College of Physicians, an organisation of internal medicine physicians, has

recommended recently in the medical journal, Annals of Internal Medicine, that clinicians

should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2

diabetes as against the traditional 6.5 to 7% which has been followed over decades. The

recommendation is leading to a conflict in views amongst doctors, with certain associations

opposing it. Doctors here say the guideline of lowering the blood sugar target cannot be

binding and should be ignored as diabetes in India is more aggressive, and, hence, riddled

DAILY NEWS BULLETINLEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE DayTuesday 20180320

with complications. They say these recommendations should not be applicable here as India

has its own three advisory bodiesthe ICMR (Indian Council of Medical Research), RSDDI

(Research Society For The Study of Diabetes in India) and API (Association of Physicians of

India)which are more tuned in to Indian cases.

Anoop Misra, chairman of Delhi-based Fortis-C-DOC (Centre of Excellence For Diabetes,

Metabolic Diseases and Endocrinology), said, In reality, Indian physicians continue to

follow US-based guidelines, hence ACP guidelines may have substantial impact in India. If

blood sugar control is loosened (as advised by ACP), more patients in India will suffer from

complications, the burden of which is already high. We should ignore these, and stick to

previous time-tested glycosylated hemoglobin limit of control of 7%.

Others concur the guidelines cannot be standardized because of several differences in

lifestyle, physiology and food habits. Dr Shashank Joshi, endocrinologist and diabetologist

who consults at Mumbais Lilavati Hospital, said, Asian Indians who develop diabetes are

insulin-resistant and have different phenotype (observable characteristics, physiological

properties, or behavior) compared to those in the western world. None of the North American

or European guidance are applicable for Indians, Chinese or Asian geographies. Also, since

Asians consume more carbohydrates, their response to medicines and doses is different.

Says Dr Rajeev Chawla, president-elect of RSSDI 2018 and senior consultant diabetologist,

Pharmacotherapy using oral or injectable agents may be used in addition to lifestyle

modification therapies to achieve a target glycosylated hemoglobin target of less than 7% for

all diabetics as far as possible to prevent complications. The RSSDI is the largest

organisation of doctors in Asia engaged in diabetes care with over 7,000 members. The

guidelines were first released in 2015 and revised in January 2018 based on Indian evidence.

Patent Law

Govt not using patent law effectively: Pharma body (The Times of India:20180320)

https://timesofindia.indiatimes.com/india/govt-not-using-patent-law-effectively-pharma-

body/articleshow/63373446.cms

The Indian Pharmaceutical Alliance, an association of 20 top Indian pharma companies that

account for 80% of the countrys exports and 46% of the domestic market, has submitted a

report to the government that says that public health safeguards in the patent law were not

being used effectively.

The IPA pointed out that an analysis of patent filings between 2007 and 2012 had shown that

a third of the patentees got away with not disclosing whether a patent was being used or not

and a third were defective or incomplete.

In a report submitted to the Indian Patents Office and the Department of Industrial Policy and

Promotion, the IPA referred to an ongoing case in the Delhi high court seeking directions to

the government to compel patentees and licensees to declare information on the working of

their patent as required under the Patent Act.

The IPA report pointed out that many subsections in the Act were introduced to safeguard

public health, prevent abuse of patent rights and ensure that patents contributed to

dissemination of technology. It added that compulsory licences were a mechanism to ensure

availability of medicines at reasonable prices especially where patents were not being used.

The use of compulsory licence was not unusual as there were 100 instances of their use

between 2001 and 2016, of which six were in the developed world, submitted the IPA.

These licences were largely for HIV (73), cancer (12) and other diseases (15). So far, India

has issued just one compulsory licence in early 2012.

Neither has India ever revoked a patent for non-working, nor has the government granted

compulsory licence for government use or for any public health imperative.

IPA pointed out that the law empowered the controller of patents to demand information from

patentees and licensees annually on how much the patent was being worked commercially.

Such information was crucial to assess the balance between incentivising innovation and

promoting public health by ensuring adequate availability of medicines at a reasonable price,

IPA said.

The alliance demanded that the patents controller place patent filings in the public domain

and make them available under the RTI Act so that civil society and NGOs could assess the

extent to which patents were being worked commercially.

Just as the controllers office had made filings for 2012, 2013 public in a searchable database,

it ought to digitize all filings and make them available in a searchable database, it added.

The alliance urged the government to ensure that patent filing was done properly and that

required forms were complete so that the controller could assess how the patent was being

used to decide on granting or revoking compulsory licences and patents.

Male birth control pill

Male birth control pill taken once a day shows success (The Times of India:20180320)

https://www.news-medical.net/news/20180319/Male-birth-control-pill-taken-once-a-day-

shows-success.aspx

A new birth control pill for men with a hormonal component has shown efficacy and safety in

preventing pregnancies when used once daily for a month. The study was presented yesterday

(18th of March 2018) at the ENDO 2018, the Endocrine Society's 100th annual meeting in

Chicago, Illinois.

The study with the new pill was tested on 83 men. It contains dimethandrolone undecanoate,

or DMAU. The pill contains the activities of male hormone testosterone and also a female

hormone progestin. It is to be taken once a day. DMAU is developed by the National

Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human

Development, that also sponsored this study.

Stephanie Page, M.D., PhD, professor of medicine at the University of Washington, Seattle,

Washington led the study. She explained that many men would opt for a once daily pill that

provides them with reversible contraception rather than go in for topical gels or long acting

injections of DMAU that would provide longer term contraception. She explained that

testosterone preparations till date have not shown success as male contraceptives because

they can lead to liver inflammation. These testosterone pills are also cleared easily and

rapidly from the body. This means at least twice daily pills are recommended. DMAU on the

other hand contains undecanoate, a long-chain fatty acid that delays its exit from the body

and allows for a single daily dose. The pills need to be taken with food to be effective, she

said.

The study started off with 100 men of whom 83 completed the study. The men were aged

between 18 and 50 and were all healthy. The study was conducted at the University of

Washington Medical Center and at Harbor-UCLA Medical Center in Torrance, CA with

assistance from Christina Wang, MD, professor of medicine at the University of California,

Los Angeles and Arthi Thirumalai, MD, Assistant professor of medicine at the University of

Washington. The participants were given three different doses of DMAU - 100, 200, and 400

mg. they were given two different formulations inside the capsules - one with powder and

one with castor oil/ benzyl benzoate. Five persons in each group received a placebo and 12 to

15 men received the DMAU pills. The pills were taken for 28 days once daily with food.

At the end of the study the 83 men gave their blood samples for testing hormone levels as

well as cholesterol levels. This had been done once at baseline as well. Results showed at

men who were given 400mg of DMAU showed marked suppression of their testosterone

levels. This led to effective contraception. Page explained that although the blood levels of

the male hormones dipped, there were no symptoms of testosterone deficiency or excess.

These men however gained weight slightly, developed mild acne and showed mild decrease

in HDL cholesterol. Their liver functions and kidney functions were however normal and the

drug was deemed safe. There were no changes in the EKG results or vital signs with this drug

use. Mood and sexual functions too remained unaltered with this pill, Page said. She added

that this study paves the way for further longer term studies with larger populations of men to

prove that taking DMAU each day regularly can block the production of sperm and provide

contraception.

Male birth control pill (The Asian Age:20180320)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10274895

Male birth control pill (Dainik Jagran:20180320)

http://epaper.jagran.com/ePaperArticle/20-mar-2018-edition-National-page_16-16253-

19564-262.html

Diabetes drug (The Asian Age:20180320)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10274894

Male Fertility (The Asian Age:20180320)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10274891

Tuberculosis

Maharashtra shows the way on how to tackle tuberculosis including a daily drug

regimen and cash transfers (The Times of India:20180320)

http://blurbstory.com/post/blogs.timesofindia.indiatimes.com/toi-edit-page/maharashtra-

shows-the-way-on-how-to-tackle-tuberculosis-including-a-daily-drug-regimen-and-cash-

transfers

India has taken major strides to fight tuberculosis (TB), which remains the countrys largest

infectious killer. Under the auspices of Prime Minister Narendra Modi, the central

government in its new National Strategic Plan for TB, has recognised TB elimination as the

foremost priority, committing unprecedented funds for the programme, including Rs 600

crore towards nutritional support for patients.

States with a high TB burden such as Maharashtra have a crucial role to play in ensuring

effective implementation of these strategies. In 2017, Maharashtra reported 2,14,102 new TB

cases of which 9,172 were cases of drug resistant TB (DR-TB). However, the Maharashtra

government has undertaken innovative strategies using latest technologies and engaging with

the private sector to expand provision of free diagnosis and treatment to all patients.

A call centre provides easy access to private providers to notify TB cases, and in turn offers

patients counselling and adherence support. The project which was piloted in Mumbai and

Nagpur, resulted in a dramatic increase in notification of TB cases and will now be scaled up

to other cities in Maharashtra.

Furthermore, a mass awareness campaign TB Harega Desh Jeetega, with the iconic

Amitabh Bachchan as its ambassador, was launched by the Municipal Corporation of Greater

Mumbai (MCGM) in 2014 and was subsequently adopted by the central government. The

widely popular campaign was disseminated across the country through various mediums.

Last year, based on WHOs recommendations, Maharashtra shifted from an intermittent to a

daily drug regimen. A new anti-TB drug, Bedaquiline, was introduced as part of the DR-TB

treatment regimen in Maharashtra and has shown successful results. CBNAAT machines

were made available for all TB patients through district hospitals and government medical

colleges to augment the states capacity for timely and accurate diagnosis of DR-TB. We

understand that delay in diagnosis increases risk of transmission, and therefore my health

staff has intensified active case finding efforts across all districts.

Additionally, to improve patient tracking and follow-ups, technology based adherence

solutions such as 99 DOTS have been rolled out across Maharashtra. Patients call in a toll

free helpline with unique numbers printed on the back of the medicine sleeves after taking

their doses. This allows programme staff to review adherence and support those who miss

their doses.

Along with free diagnosis and treatment we also recognised the importance of addressing

social determinants of TB such as malnutrition, which is both a cause and effect of TB. I am

happy to share that Maharashtra is one of the first states in the country that introduced

schemes to provide nutrition support to TB patients.

Under these schemes my government has set aside Rs 15 crore to provide nutritious food like

pulses, rice, peanuts, jaggery and wheat flour to patients with multi-drug resistant (MDR) TB

for two years across 22 municipal corporations. We are also contributing Rs 47 crore towards

cash transfers to all TB patients, and incentives for treatment providers and supporters across

the state.

Finally, TB elimination requires a multi-pronged approach with the participation of every

sector. With the new Corporate Social Responsibility strategy in place, MCGM is partnering

with donors to encourage CSR funding towards awareness, nutrition, infection control, and

community engagement initiatives.

Our success with eliminating diseases like smallpox and polio is now proof that when

political leadership, government officials, grassroots level functionaries and civil society

synergise efforts, no health challenge is unsurmountable.

I would like to share my appreciation of the incessant efforts of my ministers and secretaries

of health and medical education, mission director, state TB programme personnel right up to

the TB health visitor, extended ecosystem of healthcare providers and chemists who are

making every effort to ensure that our aim to eliminate TB is realised. I feel privileged to lead

this movement against TB in every village, town and city of Maharashtra. World TB Day

falls this week. I assure Maharashtras unflinching support to the fight against TB. TB Harega

Desh Jeetega!

Tobacco Use

Punjab to ban hookah bars (The Hindu:20180320)

http://www.thehindu.com/news/national/other-states/punjab-to-ban-hookah-

bars/article23296111.ece

The Cabinet on Monday approved amendment to the Cigarette and Other Tobacco Products

Act.

Move aimed at reducing tobacco use

The Punjab government has decided to impose a permanent ban on hookah bars in the State,

instead of issuing temporary orders against them every two months. The move is aimed at

reducing the use of tobacco in various forms.

The State Cabinet, in a meeting held here on Monday, approved an amendment to the

Cigarette and Other Tobacco Products (Prohibition of Advertisement and Regulation of

Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA 2003), for

the prevention and control of diseases caused by the use of tobacco products.

Presidential nod

The amendment would result in a complete ban on the running of hookah bars in the State.

The proposed amendment will be placed before the Legislative Assembly and, after being

passed by the House, will be reserved for the assent of the President of India, read an official

statement.

At present, Section 144 of CrPC is promulgated against all hookah bars in all the districts of

the States for two months, with extension required at the end of the period.

The Cabinet has also decided to introduce a Bill for regularisation of unauthorised colonies,

plots and buildings in the Budget Session that is slated to start from Tuesday (March 20).

The Cabinet cleared the decks for its members to pay their own income tax beginning March

2018. The draft amendment bills for relevant changes to 'The East Punjab Ministers' Salaries

Act, 1947, and 'The Salaries and Allowances of Deputy Ministers, Punjab Act, 1956,' will be

presented in the Budget session, the statement added.

It was also decided that MBBS doctors will now get their full salaries, including all

allowances, during probation period. The Cabinet has decided to do away with the condition

of basic pay only for newly appointed medical officers in the Health and Family Welfare

Department, read the statement.

Indias first womb transplant

Recipient of womb suffers abortion (Hindustan Times:20180320)

http://paper.hindustantimes.com/epaper/viewer.aspx

PUNE: Recipient of Indias first womb transplant will have to undergo a second embryo

transfer after suffering an abortion. According to doctors, the 21-yearold from Solapur, who

underwent an embryo transfer in February this year, remained pregnant for five weeks but

suffered an abortion in the sixth week.

Dr Shailesh Puntambekar, medical director of Punes Galaxy Care Laparoscopy Institute

(GCLI), where the uterine transplant and embryo transfer was performed, said, The first

recipient of the womb transplant

underwent an embryo transfer in the first week of February. A pregnancy test was conducted

after 14 days which showed she was still carrying the baby. The tests were positive for the

first five weeks and the hormonal levels were also positive. This showed that the uterus was

responsive, which is a good sign. Unfortunately, during the sixth week there was an

abortion.

Doctors said normally embryo transfer-led pregnancy is successful during the third attempt.

One of the reasons could be the recipient was prescribed immunosuppressants during the

transplant, which may have led to the abortion, said Dr Puntambekar. He said the woman will

undergo embryo transfer for the second time in the last week of March.

Doctors at a Pune hospital had conducted two uterine transplants on May 18 and May 19 last

year. The first recipient was the 21-year-old woman from Solapur who was born without a

uterus. The second transplant was successfully performed on a 24-yearold woman from

Baroda who was suffering from Ashermans Syndrome (scar tissue in the uterus).

In the last week of March, the woman from Solapur will undergo an embryo transfer for the

second time while the woman from Baroda for the first time, said Dr Puntambekar.

He said that one more uterine transplant was performed on January 26. There are two

women, a 24-year-old and a 25-year-old, who are likely to undergo uterine transplants in the

first week of April, he said.

Water crisis

Water crisis to intensify in India: Unesco report (Hindustan Times:20180320)

http://paper.hindustantimes.com/epaper/viewer.aspx

Says population growth, climate change will add to scarcity across country

NEWDELHI: A new report released by the United Nations Educational, Scientific and

Cultural Organization (Unesco) ahead of World Water Day on March 22 shows that the water

crisis will be intensifying across India by 2050. Central India is staring at deepening water

scarcity that means withdrawal of 40% of the renewable surface water resources.

Experts say the already stressed groundwater resources will face greater pressure in the

coming years.

The already stressed ground water resources will face even greater pressure in north India.

SK Sarkar, who heads the water resources division at policy think-tank TERI, said that

groundwater depletion was extremely severe in Punjab, Haryana and Delhi. Ground water

depletion carries with it the risk of salinity, he said.

South and central India will experience high levels of risk from poor water quality in its river

basins by 2050. The report relies on a study done by the International Institute for Applied

Systems Analysis for its estimations in future scenarios.

Contamination is not only a problem with surface water resources but also groundwater,

according to SWA Naqvi, a scientist at the Council of Scientific & Industrial Research

(CSIR) and NIO director, There is metallic contamination but also contamination from

improper disposal of human excreta, he said.

There is growing evidence to show that because of dumping of faecal matter in the ground -

either because of open defecation or soak-pits toilets with improper disposal of faecal matter -

- leads to contamination of groundwater aquifers with E-coli bacteria, according to experts.

The Unesco report said that over 2 billion people worldwide do not have access to safe

drinking water but almost twice that number of people do not have access to safe sanitation.

The demand for water is expected to increase by almost one-third by 2050 compared to 2010

levels.

China, India, United States, Russia and Pakistan are the largest consumers of water at present

and they will continue to be top water guzzlers in 2050.

The report attributed the water scarcity to population growth and climate change, which were

not just fuelling water scarcity but also flooding in areas that are not historically flood-prone.

According to the report ,the number of people exposed to flood risk surged from 1.2 billion to

day to 1.6 billion in 2050, and assets valued at US $45 trillion will also be at risk.

The report recommends nature-based solution that mimic nature, citing the example of small-

scale water harvesting structure in Rajasthan that quenched the water demand of 1,000

villages.

Another example of this is the underground taming of floods for irrigation (UTFI) project,

that is being piloted in the Ganga river basin. UTFI is a way of managing both flooding and

drought because the method entails channelising excess flow during the wet season for the

recharge of aquifers, thus curbing flooding downstream.

Economic Survey 2017-18

Economic Survey 2017-18: At Rs 3.3 lakh, Delhis per capita income second highest in

the country (The Indian Express:20180320)

http://indianexpress.com/article/cities/delhi/economic-survey-2017-18-at-rs-3-3-lakh-delhis-

per-capita-income-second-highest-in-the-country-5103843/

Delhi's per capita income, at Rs 3,29,093, is the second highest in the country, the report

maintains. In 2016-17, the per capita income was Rs 3,00,793

Delhis per capita income, at Rs 3,29,093, is the second highest in the country, the report

maintains (File)

The Delhi government has pegged at 19.33 per cent the tax collection growth in the 2017-18

fiscal. In 2016-17, as the economy reeled under the impact of the global slowdown and

demonetisation, tax collection growth had slumped to 3.03 per cent. As per the Economic

Survey report of 2017-18, tabled in the Delhi Assembly on Monday, tax collection in the

capital had fallen sharply in 2016-17. However, this year, the citys revenue surplus has come

down to 0.80 per cent (Budget Estimate or BE) of the Gross State Domestic Product (GSDP)

as compared to the 1.58 per cent in 2016-17.

In 2017-18, total tax collection has been projected at Rs 38,700 crore as against Rs 31,139

crore in 2016-17. Delhis per capita income, at Rs 3,29,093, is the second highest in the

country, the report maintains. In 2016-17, the per capita income was Rs 3,00,793. The survey

has revealed that all component in the tax revenue had grown this year as compared to last

year. However, the first dip after the implementation of the GST was in October . Attributing

the dip in tax collection in 2016-17 to the refunds made under various heads, Principal

Secretary (Finance) SN Sahai said, The refunds dated back to 10 years in some cases.

Maintaining that the projected growth rate of 19.33 per cent was one of the best among states

with economy as vast as that of Delhi, he said that the revenue surplus has slumped due to the

rise in expenditure under many heads, including payment of salaries following the

recommendations of the 7th Pay Commission. The survey states, All components in the tax

revenue showed a higher growth rate during 2017-18 (BE) except for other taxes on goods &

services, which have show a lesser growth of 9.66 per cent as compared to 12.70 per cent in

2016-17. It also states that there was fiscal deficit of Rs 1050.51 crore in the year 2016-17

(prov) as compared to fiscal surplus of Rs 1321.92 crore in 2015-16.

Stamps & Registration Fees registered negative annual growth of 8.39 per cent during 2016-

17 (Prov) as compared to the growth of 20.8% during 2015-16 due to the global economic

slowdown, which adversely affected the collection under the head, it reads. The survey

showed that the projected GSDP growth in 2017-18 is 11.22 per cent and the states economy

is likely to attain the size of Rs 6,86,017 crore. The advance estimate of GSDP of Delhi at

constant prices during 2017-18 was recorded at Rs 5,56,800 crore at a growth of 8.14 per cent

as compared to 2016-17.

What survey highlights

* The advance estimate of GSDP of Delhi at current prices during 2017-18 is likely to attain

level of `6,86,017 cr, at a growth of 11.22% over 2016-17

* As per advance estimate, per capital income of Delhi at current prices during 2017-18

estimated at `3,29,093 as compared to `3,00,793 in 2016-17

* Tax collection registered a growth of 3.03% in 2016-17(Prov.) as compared to growth of

13.61% in 2015-16. Tax collection for 2017-18 is budgeted with a growth of 19.33% over the

previous year

Diet/Nutrition

A big breakfast could aid weight loss, glucose control (Medical News Today:20180320)

https://www.medicalnewstoday.com/articles/321261.php

You may have heard that breakfast is "the most important meal of the day," and a new study

helps to support this. It found that eating a big breakfast and reducing lunch and dinner size

may be key for people looking to lose weight and improve their blood glucose levels.

Researchers suggest that three meals per day starting with a big breakfast could

promote weight loss and better glucose control.

Led by researchers from Tel Aviv University in Israel, the study found that adults who were

obese and had type 2 diabetes lost more weight and had better blood glucose levels after 3

months when they had a high-energy breakfast every day.

Lead study author Dr. Daniela Jakubowicz, who is a professor of medicine at Tel Aviv

University, and colleagues recently presented their results at ENDO 2018, the annual meeting

of the Endocrine Society, held in Chicago, IL.

Obesity is a leading risk factor for type 2 diabetes; excess weight makes it more difficult for

the body to use insulin the hormone that regulates blood glucose levels effectively.

According to the Obesity Society, it is estimated that around 90 percent of adults who have

type 2 diabetes are overweight or obese.

In terms of treating obesity and type 2 diabetes, switching to a more healthful diet is often the

first port of call. But, as Dr. Jakubowicz notes, it's not always what and how much we eat that

might cause problems; it's also the time of day at which we eat.

"Our body metabolism changes throughout the day," as Dr. Jakubowicz explains. "A slice of

bread consumed at breakfast leads to a lower glucose response and is less fattening than an

identical slice of bread consumed in the evening."

With this in mind, Dr. Jakubowicz and colleagues sought to find out more about how the

timing of food intake influences weight loss and blood glucose levels.

Bdiet led to weight loss, reduced hunger

The scientists enrolled 29 adults, of whom 18 were male and 11 were female, to their study.

Subjects were aged 69, on average, and all of them had obesity and type 2 diabetes.

The team randomly assigned each of the adults to two different diet groups for a total of 3

months.

One group followed the "Bdiet," and this consisted of three meals per day: a large breakfast;

a medium-sized lunch; and a small evening meal. The other group followed the "6Mdiet,"

which consisted of six small meals spaced throughout the day, plus three snacks.

How weight loss makes us hungrier

New research explains how weight loss may make us more hungry.

The researchers tested the subjects' blood glucose levels every 2 weeks during the study.

They also used continuous glucose monitoring to measure overall glucose levels, as well as

spikes in blood glucose throughout the study.

The researchers found that subjects in the Bdiet group lost an average of 5 kilograms after 3

months, while those who followed the 6Mdiet gained an average of 1.4 kilograms.

Hunger and cravings for carbohydrates also increased among subjects in the 6Mdiet group,

but these reduced significantly for subjects who followed the Bdiet.

The effects on blood glucose levels

The scientists found that the fasting glucose levels of subjects in the Bdiet group fell by an

average of 54 milligrams per deciliter (mg/dl) from 161 mg/dl to 107 mg/dl after 3

months, while fasting glucose levels of the 6Mdiet diet group fell by just 23 mg/dl, from 164

mg/dl to 141 mg/dl.

Upon looking at overall mean glucose levels, the team found that these dropped by 29 mg/dl

in the first 14 days from 167 mg/dl to 138 mg/dl for subjects who followed the Bdiet,

while they fell just 9 mg/dl among the 6Mdiet diet group, from 171 mg/dl to 162 mg/dl.

At 3 months, overall mean glucose levels decreased by 38 mg/dl in the Bdiet group from

167 mg/dl to 129 mg/dl compared with a reduction of 17 mg/dl in the 6Mdiet diet group,

from 171 mg/dl to 154 mg/dl.

Mean glucose levels during sleep did not reduce at all for those subjects who followed the

6Mdiet diet, but subjects in the Bdiet group experienced a reduction of 24 mg/dl from 131

mg/dl to 107 mg/dl at 3 months.

Those who adhered to the Bdiet also required less insulin during the study period, with a

reduction in 20.5 units each day. Subjects who followed the 6Mdiet diet, however, needed

more insulin, with an increase of 2.2 units every day.

Meal timing offers benefits in itself

Notably, the study also revealed that participants adhering to the Bdiet experienced a

significant decrease in overall blood sugar levels in as little as 14 days, even when the

subjects themselves showed no weight loss.

According to the researchers, this finding indicates that the timing of meals itself can help

with blood glucose management, though weight loss can help to enhance the benefits.

Overall, the team concludes that three meals each day with breakfast being the biggest

may be of great benefit to people with obesity and type 2 diabetes.

"This study shows," says Dr. Jakubowicz, "that, in obese, insulin-treated type 2 diabetes

patients, a diet with three meals per day, consisting of a big breakfast, average lunch, and

small dinner, had many rapid and positive effects compared to the traditional diet with six

small meals evenly distributed throughout the day."

These "positive effects" included "better weight loss, less hunger, and better diabetes control

while using less insulin."

"A diet with adequate meal timing and frequency has a pivotal role in glucose control and

weight loss."

Breast Cancer

Breast cancer: Obesity may hinder some treatments (Medical News Today:20180320)

https://www.medicalnewstoday.com/articles/321251.php

Obesity may be the reason that some cancers become resistant to drugs intended to stop the

formation of new blood vessels that fuel tumor growth, according to recent research led by

Massachusetts General Hospital in Boston.

Could obesity prevent some cancer treatments from working correctly?

In a paper now published in the journal Science Translational Medicine, the researchers

explain how obesity and molecular factors linked to it may promote resistance to anti-

angiogenic inhibitors in breast cancer.

Anti-angiogenic therapy which is designed to prevent the growth of blood vessels that

feed tumors is showing mixed results in people with breast and other cancers.

It is also well known that obesity raises the risk of many types of cancer, including breast

cancer.

The new study is the first to show a link between these two "observations." It also offers

some molecular targets that might improve response to treatment with anti-angiogenic

inhibitors.

"Collectively," explains lead study author Dr. Joao Incio, of the Department of Radiation

Oncology at Massachusetts General Hospital, "our clinical and preclinical results indicate

that obesity fuels resistance to anti-vascular endothelial growth factor therapy in breast cancer

via production of several inflammatory and pro-angiogenic factors, depending on the subtype

of cancer."

"Targeting these resistance factors," he continues, "may rejuvenate the use of anti-angiogenic

therapy in breast cancer treatment."

Angiogenesis and its inhibition

Angiogenesis is a natural process in the body that repairs and grows blood vessels. Some

chemical signals stimulate the process and some chemical signals inhibit it. Levels of these

are normally kept in balance so that blood vessels are made only when and where necessary.

These processes also play a key role in cancer. Without a dedicated blood supply, tumors

cannot grow and spread. However, they do so because they also generate chemical signals

that trigger angiogenesis, resulting in the growth of blood vessels that keep them fed with

oxygen and nutrients.

Breast cancer: Body fat, not weight, poses major risk

Learn how even women of a normal weight may be at increased risk of invasive breast cancer

if they have high levels of body fat.

Angiogenesis inhibitors are drugs that are designed to interfere with the chemical signals

involved in angiogenesis. One of these drugs blocks vascular endothelial growth factor

(VEGF), a signaling molecule that triggers growth of new blood vessels when it binds to

proteins on cell surfaces.

However, Dr. Incio and his colleagues found that obesity "promotes resistance to VEGF

inhibitor therapy" by altering chemical signals in tumors. They note that it increases

"interleukin-6 [IL-6] and possibly also fibroblast growth factor 2 [FGF-2] in the tumor

microenvironment."

The team also discovered with the help of "mouse models of cancer with and without

obesity" that resistance to VEGF inhibitors may be overcome by using the "appropriate

combination therapy."

Obesity, anti-VEGF therapy in breast cancer

The researchers started their investigation by analyzing the results of a clinical trial that tested

the anti-VEGF drug bevacizumab, with and without chemotherapy, in 99 people with breast

cancer.

Promising results from early clinical trials had led to the accelerated approval of the drug for

the treatment of metastatic breast cancer in the United States. But approval was then

withdrawn after subsequent studies found no evidence of benefit to long-term survival.

The trial that Dr. Incio and his colleagues investigated had shown that bevacizumab only

benefited a small percentage of people.

When the researchers analyzed the trial data, they found that people whose body mass index

(BMI) was 25 or higher that is, if they fell into the overweight or obese category had

larger tumors when they were diagnosed.

On average, these people had tumors that were 33 percent bigger than those whose BMI was

under 25.

In addition, tissue samples from people who had more body fat revealed that their tumors had

a smaller blood supply, which is known to reduce the effects of chemotherapy.

Further examination showed that people with a higher BMI had higher circulating levels of

two molecules: IL-6, which promotes inflammation, and FGF-2, which promotes

angiogenesis.

There was also evidence that these factors were present in fat cells and adjacent cells in the

tumors.

The role of IL-6 and FGF-2 in mouse models

In the next stage of the study, the researchers sought to confirm these findings in mouse

models of breast cancer, both with and without obesity. They used two models: one of breast

cancer that is positive for the estrogen receptor (ER), and the other of triple-negative breast

cancer.

They found, in the case of the obese mice, that the tumor microenvironments which

contained many fat cells and had reduced levels of oxygen responded poorly to anti-VEGF

treatment. Morever, at a molecular level, responses differed depending on the breast cancer

subtype.

For example, in obese mice with ER-positive breast cancer, the fat cells and some types of

immune cell had higher levels of several pro-inflammation and pro-angiogenic molecules

including IL-6.

The researchers found that when they blocked IL-6 in the ER-positive obese mice, the

animals' responses to anti-VEGF therapy improved and matched that of the lean mice.

Obese mice with triple-negative breast cancer, on the other hand, showed higher levels of

FGF-2 but not of IL-6. In their case, blocking FGF-2 raised their response to treatment to that

of the lean mice.

Blocking either of those molecules in lean mice with either type of breast cancer did not

improve their response to anti-VEGF treatment.

"This is the first study to propose that markers such as body mass index could help

personalize anti-VEGF therapy, with blockade of molecules like IL-6 or FGF-2 for

overweight or obese cancer patients."

Dr. Joao Incio

The researchers note that there are several inhibitors of the two pathways are already

available. For example, to inhibit FGF-2 in their experiments, they used the widely used

diabetes drug metformin, which has been showing promise in slowing the growth of some

cancers.

Neuroscience

Targeting these brain cells may aid weight loss (Medical News Today:20180320)

https://www.medicalnewstoday.com/articles/321236.php

A new study in mice investigating a brain region that controls the animals' impulses to "feed

or flee" may have implications for obesity and anxiety in humans, according to its authors.

What controls hunger? Researchers investigate.

We know that both too much and too little food can be bad for us. Too little? Stunted growth.

Too much? Obesity. The latter can also open the door to diabates, cardiovascular disease, and

cancer.

Studies show that the brain mechanisms that are involved in feeling hungry are highly

complex.

For instance, it seems that the nerve signals telling us when it is acceptable to eat are also

fired from the same neurons that tell us when to run from danger.

This finding has led scientists to consider whether investigating this mechanism further might

provide clues to new treatment targets for obesity or psychiatric conditions that are linked to

anxiety.

The researchers behind the new study from Imperial College London in the United

Kingdom set out to examine this brain mechanism, particularly in regard to a region of the

brain called the ventromedial hypothalamus (VMH), which has been a subject of interest in

obesity research for a long time.

'Control switch' for feed-or-flee mechanism

In their study which has now been published in the journal Cell Reports the researchers

used mice with neurons that had been genetically modified to be stimulated by a laser light.

This modification allows scientists to toggle brain regions "off" and "on" by focusing the

laser on the required area. When they did this to the VMH, they discovered that a group of

cells called SF1 act as a "control switch" for the feed-or-flee mechanism.

Can't keep the weight off? This may be why

If you're struggling to stay slim, these brains cells may be to blame.

SF1 cells are normally very active when mice are anxious such as when they explore a

new environment but the researchers found that SF1 activity "dampens down" when the

mice approach food.

The researchers say that SF1 effectively switches the activity of the VMH from defensive

behavior to "need to feed" when the animals discover food. But when the animals' guards

were dropped while feeding, the VMH switched back to defensive after eating.

Further investigation showed that the researchers could manipulate SF1 activity in the mice.

By making the mice more stressed, they found that they could switch the VMH back to

defensive mode, which prevented the mice from being hungry.

When the team administered drugs to the mice to increase activity in their SF1 neurons, the

animals were less likely to want food and stored less fat. Dampening down SF1 activity made

the mice feel less anxious, but it also made them eat more and put on more weight.

"We have shown for first time," says study co-author Dominic Withers, of Imperial College

London's Institute of Clinical Sciences, "that activity in this small population of brain cells

acutely changes food intake. That hadn't been shown before."

Eating disorders and stress in humans

Withers and team believe that their findings could be relevant for studies of eating disorders

and stress in human subjects.

"There's a long-standing recognition," he says, "that things like obesity are associated with

altered anxiety states and altered emotions and depression, so it is a bit of a chicken and egg

as to which came first."

Withers believes that small-molecule drugs targeting the SF1 neurons or other relevant "fine

control mechanisms" in the brain may have greater potential than some existing treatments.

These are less precise in targeting and therefore have a greater risk of creating unintended

adverse effects.

"At the moment we're only in the foothills of discovering how the brain works, particularly

the appetite regulatory circuits. But when you start combining these new tools in the lab,

we're really moving into a revolution in brain science."

Dominic Withers

World Happiness Day (Hindustan:20180320)

http://epaper.livehindustan.com/story.aspx?id=2618036&boxid=121613918&ed_date=2018-

03-20&ed_code=1&ed_page=10

Sex Ratio (Dainik Jagran:20180320)

http://epaper.jagran.com/ePaperArticle/20-mar-2018-edition-National-page_15-16252-

20009-262.html

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(Dainik Bhaskar:20180320)

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