HEALTH TRIBUNE Wednesday, June 12, 2002, Chandigarh, India
 


Obese? Donít lose heart
B.L. Kawatra
O
BESITY is a condition in which there is an excess amount of fat stored in the body. It is a reflection of disordered energy balance resulting from energy input being in excess of its output. Obesity is widely prevalent in several developing countries, particularly those in rapid transition, and is affecting both adults and children.

Amoebiasis: causes and prevention
Archana Sood
A
MOEBIASIS is a worldwide parasitic disease. It creates many medical and surgical problems. About 15 to 20 per cent of Indians are affected by the parasite. It can be acute and chronic and can have intestinal and extra-intestinal manifestations.

INFO CAPSULE
Infertility in India

ONE out of six couples in India suffers from the inability to procreate while infertility is estimated to have increased by around 7 per cent among Indiaís women in the past three years, according to a Organon fertility survey. "The population of infertile couples in India is 15 million compared to six million in the USA," the survey said.

  • Diseases of the aged

  • Hepatitis-B vaccine row

  • Controlling cholesterol

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Obese? Donít lose heart
B.L. Kawatra


(A) Apple-shaped or upper body obesity
(B) Pear-shaped or lower body obesity

OBESITY is a condition in which there is an excess amount of fat stored in the body. It is a reflection of disordered energy balance resulting from energy input being in excess of its output. Obesity is widely prevalent in several developing countries, particularly those in rapid transition, and is affecting both adults and children.

A complex network of genetic, nutritional, physiological, psychological and social factors is involved in the pathogenesis of obesity. The normal proportion of body weight as fat is 15-20 per cent for men and 20-25 per cent for women. The pattern of fat distribution throughout the body affects metabolic consequences. A person with fat located predominantly in the abdominal region, the so-called apple-shaped or upper body obesity (Fig. A), may be at greater risk of some chronic diseases than another person with a greater total amount of adipose tissue that is located predominantly in the gluteal (buttocks) area.

Upper body obesity is common in males. In contrast, fat distributed in the lower extremities around hips or femoral region is characterised as pear-shaped or lower body obesity (Fig. B) and is common in females. The abdominal fat mass in any individual can vary for the same amount of total body fat. During the accumulation of any total body fat, males on an average have twice as much abdominal fat as compared to pre-menopausal females. Different ethnic groups in the population have marked differences in the risk of co-morbidities associated with abdominal fat accumulation. South Asians are more prone to the associated co-morbidities of abdominal obesity than Europeans. A strong association exists between overweight and adult onset diabetes. The prevalence of diabetes is about 2.9 times higher in overweight than in normal weight individuals.

Life insurance statistics reveal that when the body weight is 10 per cent above average, life expectancy decreases by 11 per cent in men and 7 per cent in women. In the case of individuals who are 20 per cent above ideal weight life expectancy decreases even further by 20 per cent for men and 10 per cent women.

Obese can be treated either by reducing energy intake or by increasing energy expenditure. Such individuals must give up those habits permanently which have led to obesity; otherwise the reduction in weight which he/she can expect to obtain from an anti-obesity diet will not be maintained when dietary restrictions are somewhat relaxed. Though the practice of weight reduction appears to be simple, it is very difficult to maintain. The desirable rate of weight loss is about of 0.5 kg a week. One kilogram of body adipose tissue provides 7000 Kcal of energy. Therefore, a daily energy gap of 500-1000 Kcal in the diet will provide a weekly loss of 0.5 to 1 kg of body adipose tissue.

A drastic restriction of energy is not advisable as it leads to hunger, nervous exhaustion, weakness and inadequacy of other nutrients. The food items normally eaten and their mode of preparation being followed by obese need to be worked out before proceeding for any new well-balanced diet plan. While working on the diet plan, care should be taken that it does not deviate too much from the established food habits.

For the treatment of obesity it is essential to regulate the daily intake of energy. First make a practice of weighing what you are about to eat, and this should be continued until you become accustomed to judging correctly the quantities of food. A suitable food balance for this on kitchen table is needed. Foods such as fats, sugars and alcohol, providing empty calories, should be restricted maximally and low calorie foods such as vegetables and fruits should be encouraged to provide not only less calories but also to enhance the intake of fibre and antioxidant nutrients.

For average obese men and women, a diet supplying 1500 Kcal a day and 1000 Kcal a day is advised respectively. The diet which provides about 1000 Kcal can be made up from about 50 g protein, 20 g fat and 160 g of carbohydrate or somewhat more for active men. In a severe case of obesity, very low calorie diets (800 Kcal or less are advised. To lose weight by a very low calorie diet is a drastic approach. Sometimes it leads to acidosis, hypertension and lowered basal metabolic rate (BMR). It is used for very obese individuals, but under strict medical supervision.

Patients should eat at scheduled times, and eating in between meals is to be avoided. Frequent eating outside the house or at a friendís place should be avoided. The consumption of fried foods (puri, samosa, parantha, etc.), ice cream, khoa, egg yolk, sugar, jaggery, pastries, cake, jam, jelly, soft drink, dry fruits, chocolates, candy, etc, should be avoided. Intake of mango, grapes and banana should be moderate, as these are energy-dense fruits. An adequate amount of fresh vegetables and fruits should be consumed as these are good sources of vitamins and minerals. Skimmed milk can replace whole milk. Legumes can be sprouted and consumed. This will enhance the bioavailability of protein and minerals and the quantity of B-complex vitamins.

The crucial technique of managing obesity is to alter oneís eating behaviour permanently and make exercise a part of lifestyle. Exercise like cycling, jogging, outdoor games, walking, treadmill, yogasana, etc, are valuable as these tone up muscle and increase energy expenditure. An hourís walk at three miles an hour will expend about 300 Kcal, which is approximately equivalent to the energy value of 30 g of fat. If the daily walk becomes a habit, it adds up to a weight loss of over 9 kg in a year. Aerobic activity sustained for a period of 30 minutes five times per week is considered appropriate.

The writer is a former Professor, Food and Nutrition, Punjab Agricultural University, Ludhiana.

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Amoebiasis: causes and prevention
Archana Sood

AMOEBIASIS is a worldwide parasitic disease. It creates many medical and surgical problems. About 15 to 20 per cent of Indians are affected by the parasite. It can be acute and chronic and can have intestinal and extra-intestinal manifestations.

The causative organism is a protozoa which remains in the large intestine and can be transmitted to other organs like liver, lungs, brain, spleen and skin etc. It is transmitted through contaminated food, water and infected human feaces.

Amoebiasis can occur at any age. There is no sex or racial difference in the occurrence of the disease. It is a household infection and the human being is responsible for spreading the disease. Most of the infected people remain asymptomatic (without symptoms) and are called as healthy carriers. If one person in a family gets infected with the parasite, other family members are at the great risk of infection. The human carrier can discharge upto 1.5x107 cysts per day.

Mode of transmission: The causative organism responsible for the disease is entamoeba histolytica which exists in the human colon in two forms: motile trophozoile; and non-motile cyst.

The motile trophozoile is not an infected form whereas non-motile cyst is the infected one. The infection is transmitted by cyst through ingestion. People discharge cyst in the stool. The cyst remains live outside the body for days to weeks. It will die quickly if it is not kept cool and moist. So the infection is transmitted from one person to another through contaminated water. Food handlers are also the immediate source of infection, if they are the healthy carriers. While handling the food, they transmit the cyst in the food.

Signs and symptoms: colicky abdominal pain; diarrhoea ó Intermittent, watery, foul smelling stool may contain blood and mucus. The person passes stool seven to ten times in 24 hours; loss of appetite; and malaise. The symptoms may alternate with constipation in chronic cases.

Diagnosis: consultation of a physician gastroentrologist; stool specimen ó Three fresh stool specimens help diagnosis of 90 per cent of patients; sigmoidos copy: (Diagnostic test to visualise the colon).

Treatment for carriers: idoquinot 650 mg x eight times a day for 20 days; furamide 500 mg x eight times a day for 10 days; and paromomycin 25-30 mg/kg/day in divided three doses for seven days.

Mild to moderate: metronidezole 750 mg thrice a day x 10 days. No medicine should be taken without the prescription of the physician/gastroentrologist. Self-medication is harmful than cure.

Prevention:

1. Improvement of sanitary conditions: The sanitary conditions should be improved. As mentioned earlier, the cyst can survive days to weeks in cool and moist conditions. So proper disposal of human excreta should be there.

2. Control of flies: Flies should be controlled at living places. The flies must be eradicated from the house as they are responsible to transmit the disease from one place to another. Foods and eatables should be covered and properly cooked before eating.

3. Safe drinking water: Drinking water should be boiled. If one can afford, water filter should be used.

4. Hand washing: Hand washing practices are also very helpful to control the infection. Hands should be properly washed with soap and water after defecation. Especially before eating and preparing the food, hands should be washed properly.

5. Washing of vegetables: Ground grown vegetables like carrot, turnip, radish, should be washed thoroughly by running water. During infection, these vegetables should be avoided because these may be contaminated with human feaces.

The right way to treat amoebiasis is through proper diagnosis and treatment prescribed by the qualified physician/gastroentrologist.

The writer is Vice-Principal, School of Nursing, Dayanand Medical College &Hospital, Ludhiana.

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INFO CAPSULE
Infertility in India

One out of six couples in India suffers from the inability to procreate while infertility is estimated to have increased by around 7 per cent among Indiaís women in the past three years, according to a Organon fertility survey. "The population of infertile couples in India is 15 million compared to six million in the USA," the survey said.

"Infertility has been relatively neglected as a health problem in South Asia. But these figures are more significant in a country like India where children are accepted as an integral part of the cultural and social fabric," say Mr Jagdish Singh, the marketing controller of Infar India, a subsidiary of the Netherlands-based pharmaceutical major Organon. UNI

Diseases of the aged

Advances in medical science have lengthened the lifespan of the average American, but now as the population in general grows older, there is an increased need for new and better treatment of diseases that affect the elderly ó Alzheimerís, Parkinsonís, osteoporosis, cancer and arthritis ó with the potential profit from the various drug treatments for these ills growing along with the aging population. According to the "World Aging Report, 2000-2001, A Global Population Growing Greyer" from the American Academy of Anti-Aging Medicine, the World Health Organisation estimates that by 2025, one of every 10 persons in this country will be age 65 or over.

"In order to avert the financially, socially, and medically burdensome task of caring for the swelling aging population, adoption of safe and effective diagnostic treatment processes that can improve the quality of life is requisite," the report states. UPI

Hepatitis-B vaccine row

Serious apprehensions have been expressed about the health risks of the hepatitis-B vaccine in infants and adults. The controversy about the vaccineís adverse reports has, therefore, led many to question the administration of the vaccine.

A non-governmental organisation says that hepatitis-B vaccine can pose a health hazard, including death, in some people. America and France have already suspended their programme of giving this vaccine to all the infants because of its reported serious adverse reactions. According to the National Vaccination Information Centre (NVIC), in the USA in1996 alone there were 872 serious adverse reactions in children under 14 years, and 13 deaths after the administration of hepatitis-B vaccine. Prof Bhaskar Rao, a cardio-theracic surgeon, has disclosed that he received 70 phone calls complaining of adverse reactions of this vaccine, including death of two children. He said, "the victims donít come forward and approach the doctor for the adverse reactions. INFA

Controlling cholesterol

Very few of us have intimate knowledge of the biochemical working of the body. Yet, one blood constituent practically all of us know something about is the waxy, fat-like substance known as cholesterol. Too much cholesterol whizzing around our blood streams, we are told, can clog our arteries and up our risk of falling prey to problems such as heart attack and stroke. While 20 years ago virtually no one had even heard of the stuff, many of us are now as familiar with our cholesterol score as our golfing handicap or bra size.

The rising popularity of cholesterol has led to an inevitable expansion in the numbers of people concerned about keeping their cholesterol level in check. For anyone keen to do what they can to exert control in this area, the diet is an obvious place to start. Traditionally individuals harbouring a higher-than-desirable cholesterol level are advised to eat less fat. But low fat diets tend to produce quite modest results in terms of cholesterol reduction. One reason for this may be that the majority of cholesterol floating around the bloodstreams doesnít come from fat in the diet; itís made in the liver. One important stimulus for the production of cholesterol by the liver is the hormone insulin, which is secreted in response to carbohydrates such as sugars and starch. Counterintuitive though this may seem, many individuals get good control over cholesterol by going easy on their consumption of bread, potatoes, rice and pasta. Observer News Service

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