How do sustainable diets fit into the climate agenda?

Food production is a major driver of greenhouse gas (GHG) emission and other environmental footprints, and dietary risk factors are contributors to non-communicable diseases. A growing body of evidence has shown that changes in what and how much we eat can offer benefits for both the environment and health. However, several data gaps and complexities remain in this research area. A better understanding and increased uptake of sustainable diets will require further research, investment, and interdisciplinary collaboration

PERFORMANCE OF CHEST COMPRESSIONS WITH THE USE OF THE NEW MECHANICAL CHEST COMPRESSION MACHINE LIFELINE ARM: A RANDOMIZED CROSSOVER MANIKIN STUDY IN NOVICE PHYSICIANS

BACKGROUND: The Lifeline ARM (ARM; De btech, Guilford, USA) is a new mechanical chest compression device. The aim of the current study was to compare the quality of single rescuer cardiopulmonary resuscitation (CPR) with and without ARM device. METHODS: In this randomized crossover manikin trial forty-four novice physicians participated. Thirty minutes of training was allotted for manual CPR and then for the ARM. The following day, every participant performed a 2-min CPR single rescuer scenario, once with manual CPR and once with the ARM. The primary outcome measure of the study is effective compression; de ned as compressions performed with the correct of depth of 50–60 mm, complete decompressions, and the correct pressure point of CC. RESULTS: The ARM, compared with manual CPR, carried out more effective compressions (96 [interquartile range, IQR; 94–98] vs. 36 [IQR; 33–41]%, p < 0.001). The compressions preformed with the use of the ARM, furthermore, were with a correct CC rate (100 [IQR; 99–101] vs. 130 [IQR; 124–140] min-1; p<0.001) and a correct depth (97 [IQR; 96–98] vs. 37 [IQR; 31–39]%; p<0.001). The result of resuscitation with ARM was signi cantly better than manual CPR (p<0.05) for all of the analyzed chest compression parameters (percentage of CC too deep, percentage of CC too shallow, percentage of correct pressure points and percentage of correct pressure releases), as well as for the ventilation parameters (tidal volume, ventilation rate, minute-volume, gastric in ations). CONCLUSION: During this simulated trial, when CPR was performed by novice physicians, the ARM signi cantly improved the quality of CPR. Further clinical trials should provide motivation to con rm the potential bene ts of ARM use during CPR

Dietary patterns and non-communicable disease risk in Indian adults : secondary analysis of Indian Migration Study data

Acknowledgements The authors thank the IMS study team members and field staff involved in the generation and processing of IMS data. Financial support: This study forms part of the Sustainable and Healthy Diets in India (SAHDI) project supported by the Wellcome Trust ‘Our Planet, Our Health’ programme (grant number 103932). The Wellcome Trust had no role in the design, analysis or writing of this article. The IMS was funded by Wellcome Trust (grant number GR070797MF). L.A.’s PhD studentship is funded by the Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH).Peer reviewedPublisher PD

Projected health effects of realistic dietary changes to address freshwater constraints in India : a modelling study

Acknowledgements This study forms part of the Sustainable and Healthy Diets in India project supported by the Wellcome Trust's Our Planet, Our Health programme (grant number 103932). LA's PhD is funded by the Leverhulme Centre for Integrative Research on Agriculture and Health. SA is supported by a Wellcome Trust Capacity Strengthening Strategic Award-Extension phase (grant number WT084754/Z/08/A). We would like to thank Zaid Chalabi (London School of Hygiene & Tropical Medicine) for providing valuable guidance on the modelling methods.Peer reviewedPublisher PD

Childhood Cancer Mortality in India: Direct Estimates From a Nationally Representative Survey of Childhood Deaths.

PURPOSE: Although most children with cancer live in low- and middle-income countries, measurements of childhood cancer burden in such countries have been restricted to incidence rates from a few subnational cancer registries and mortality rates from vital statistics. We aimed to provide alternative burden estimates by using nationally representative longitudinal survey-derived mortality rates. METHODS: We examined cancer deaths in childhood (1 month to 14 years of age) in the Million Death Study, a cohort of > 27,000 pediatric deaths in India on the basis of enhanced verbal autopsies. All deaths potentially due to childhood cancer were identified. Two pediatric specialists independently categorized deaths as definite, probable, possible, or unlikely cancer related. From definite and probable deaths, we estimated national and regional mortality rates attributable to childhood malignancies. Data on symptoms and health care-seeking behavior were abstracted from closed-ended questions and caregiver narratives. RESULTS: Of 700 included deaths, 189 were classified as definite or possibly cancer related. The κ-statistic between reviewers was 0.75 (95% CI, 0.71 to 0.78). From these deaths, we estimated that in 2010, 13,700 were a result of childhood cancer in India, which led to a mortality rate of 37 (95% CI, 31 to 42) per million population per year, which exceeds many prior estimates of mortality and even some estimates of incidence. Disparities between mortality estimates were widest in northeast India and for brain tumors. A preponderance of male deaths was seen (male:female ratio, 1.6:1). CONCLUSION: The burden of childhood cancer in India is substantially higher than previously suggested. This information will aid advocacy for national strategies aimed at improving outcomes for Indian children with cancer

What underlies inadequate and unequal fruit and vegetable consumption in India? An exploratory analysis

Adequate consumption of fruit and vegetables is key to improved diet-related health in India. We analyse fruit and vegetable consumption in the Indian population using National Sample Survey data. A series of regressions is estimated to characterise the distribution of household fruit and vegetable consumption and explore key socio-economic and food system drivers of consumption. Household income and price are important correlates, but consumption is also higher where households are headed by females, are rural, or involve agricultural livelihoods. Caste is an important source of inequality, particularly amongst those with low consumption, with Scheduled Tribes consuming less F&V than others. We also find preliminary evidence that formal agricultural market infrastructure is positively associated with fruit and vegetable consumption in India

Performance criteria for verbal autopsy-based systems to estimate national causes of death: development and application to the Indian Million Death Study.

BACKGROUND: Verbal autopsy (VA) has been proposed to determine the cause of death (COD) distributions in settings where most deaths occur without medical attention or certification. We develop performance criteria for VA-based COD systems and apply these to the Registrar General of India's ongoing, nationally-representative Indian Million Death Study (MDS). METHODS: Performance criteria include a low ill-defined proportion of deaths before old age; reproducibility, including consistency of COD distributions with independent resampling; differences in COD distribution of hospital, home, urban or rural deaths; age-, sex- and time-specific plausibility of specific diseases; stability and repeatability of dual physician coding; and the ability of the mortality classification system to capture a wide range of conditions. RESULTS: The introduction of the MDS in India reduced the proportion of ill-defined deaths before age 70 years from 13% to 4%. The cause-specific mortality fractions (CSMFs) at ages 5 to 69 years for independently resampled deaths and the MDS were very similar across 19 disease categories. By contrast, CSMFs at these ages differed between hospital and home deaths and between urban and rural deaths. Thus, reliance mostly on urban or hospital data can distort national estimates of CODs. Age-, sex- and time-specific patterns for various diseases were plausible. Initial physician agreement on COD occurred about two-thirds of the time. The MDS COD classification system was able to capture more eligible records than alternative classification systems. By these metrics, the Indian MDS performs well for deaths prior to age 70 years. The key implication for low- and middle-income countries where medical certification of death remains uncommon is to implement COD surveys that randomly sample all deaths, use simple but high-quality field work with built-in resampling, and use electronic rather than paper systems to expedite field work and coding. CONCLUSIONS: Simple criteria can evaluate the performance of VA-based COD systems. Despite the misclassification of VA, the MDS demonstrates that national surveys of CODs using VA are an order of magnitude better than the limited COD data previously available

Comparison of food consumption in Indian adults between national and sub-national dietary data sources

Accurate data on dietary intake are important for public health, nutrition and agricultural policy. The National Sample Survey is widely used by policymakers in India to estimate nutritional outcomes in the country, but has not been compared with other dietary data sources. To assess relative differences across available Indian dietary data sources, we compare intake of food groups across six national and sub-national surveys between 2004 and 2012, representing various dietary intake estimation methodologies, including Household Consumption Expenditure Surveys (HCES), FFQ, food balance sheets (FBS), and 24-h recall (24HR) surveys. We matched data for relevant years, regions and economic groups, for ages 16–59. One set of national HCES and the 24HR showed a decline in food intake in India between 2004–2005 and 2011–2012, whereas another HCES and FBS showed an increase. Differences in intake were smallest between the two HCES (1 % relative difference). Relative to these, FFQ and FBS had higher intake (13 and 35 %), and the 24HR lower intake (−9 %). Cereal consumption had high agreement across comparisons (average 5 % difference), whereas fruit and nuts, eggs, meat and fish and sugar had the least (120, 119, 56 and 50 % average differences, respectively). Spearman’s coefficients showed high correlation of ranked food group intake across surveys. The underlying methods of the compared data highlight possible sources of under- or over-estimation, and influence their relevance for addressing various research questions and programmatic needs

Future diets in India: A systematic review of food consumption projection studies

Against a backdrop of a rapidly changing food system and a growing population, characterisation of likely future diets in India can help to inform agriculture and health policies. We systematically searched six published literature databases and grey literature repositories up to January 2018 for studies projecting the consumption of foods in India to time points beyond 2018. The 11 identified studies reported on nine foods up to 2050: the available evidence suggests projected increases in per capita consumption of vegetables, fruit and dairy products, and little projected change in cereal (rice and wheat) and pulse consumption. Meat consumption is projected to remain low. Understanding and mitigating the impacts of projected dietary changes in India is important to protect public health and the environment