Importance of folate in human nutrition

From a public health perspective, some of the new insights into folic acid nutrition are of significance. Folate intake recommendations vary under different conditions. Intake of 350 µg is required to maintain plasma homocysteine levels, 650 µg for those with elevated plasma homocysteine, about 400 µg for women planning to become pregnant and 4000 mg for those with history of neural tube defect affected pregnancy. This raises the question whether the folate intake is adequate for the general population, particularly in the vulnerable groups or whether there is a need for scientists to take a fresh view of the requirements, recommended dietary intakes, and consider intervention measures which will have impact on the folate nutritional status. The recommendations should provide a margin of safety to allow for decreased intake, increased requirements, individual variability and bioavailability of natural food folates. The folate intake and nutriture in relation to India and other developing countries needs careful consideration to reduce anemia, neural tube defects and possibly impact on the high incidence of cardiovascular diseases

Field testing of an onsite sanitation system on apartment building blackwater using biological treatment and electrochemical disinfection

The Closed Loop Advanced Sanitation System (CLASS) was designed to treat, disinfect, and recycle toilet blackwater from existing flush toilets in a multi-story apartment building. Two systems were tested at two unique sites in Coimbatore, India for a combined 7500+ treatment hours resulting in more than 180 000 L of treated water. The CLASS prototypes used a combination of biological pretreatment and electrochemical oxidation processes to produce treated water that nearly met the stringent requirements outlined in the standard ISO 30500. The nutrient and organic loading from the toilet blackwater was predominantly reduced by over 85–95% and 80–87%, respectively, through biological processes that were achieved using either a sequencing batch reactor (SBR, site A) or an anaerobic–aerobic biodigester (EcoSan, site B). Complete disinfection of E. coli with nil CFU per ml was achieved using electrochemical processes that also served to remove the remaining organic and nutrient loading to over 90–96%. The treated water was reused for flushing by the residents of the apartment building for 89 days

Field testing of an onsite sanitation system on apartment building blackwater using biological treatment and electrochemical disinfection

The Closed Loop Advanced Sanitation System (CLASS) was designed to treat, disinfect, and recycle toilet blackwater from existing flush toilets in a multi-story apartment building. Two systems were tested at two unique sites in Coimbatore, India for a combined 7500+ treatment hours resulting in more than 180 000 L of treated water. The CLASS prototypes used a combination of biological pretreatment and electrochemical oxidation processes to produce treated water that nearly met the stringent requirements outlined in the standard ISO 30500. The nutrient and organic loading from the toilet blackwater was predominantly reduced by over 85–95% and 80–87%, respectively, through biological processes that were achieved using either a sequencing batch reactor (SBR, site A) or an anaerobic–aerobic biodigester (EcoSan, site B). Complete disinfection of E. coli with nil CFU per ml was achieved using electrochemical processes that also served to remove the remaining organic and nutrient loading to over 90–96%. The treated water was reused for flushing by the residents of the apartment building for 89 days

Study protocol for a randomised controlled trial of brief, habit-based, lifestyle advice for cancer survivors: exploring behavioural outcomes for the Advancing Survivorship Cancer Outcomes Trial (ASCOT)

Introduction Positive health behaviours such as regular physical activity and a healthy diet have significant effects on cancer outcomes. There is a need for simple but effective behaviour change interventions with the potential to be implemented within the cancer care pathway. Habit-based advice encourages repetition of a behaviour in a consistent context so that the behaviour becomes increasingly automatic in response to a specific contextual cue. This approach therefore encourages long-term behaviour change and can be delivered through printed materials. ‘Healthy Habits for Life’ is a brief intervention based on habit theory, and incorporating printed materials plus a personally tailored discussion, that has been designed specifically for patients with a diagnosis of cancer. The aim of this trial was to test the effect of ‘Healthy Habits for Life’ on a composite health behaviour risk index (CHBRI) over 3 months in patients with a diagnosis of breast, colorectal or prostate cancer. Method and analysis A 2-arm, individually randomised controlled trial in patients with breast, colorectal and prostate cancer. Patients will be recruited over 18 months from 7 National Health Service Trusts in London and Essex. Following baseline assessments and allocation to intervention or usual care, patients are followed up at 3 and 6 months. The primary outcome will be change in CHBRI at 3 months. Maintenance of any changes over 6 months, and changes in individual health behaviours (including dietary intake, physical activity, alcohol consumption and smoking status) will also be explored. Ethics and dissemination Ethical approval was obtained through the National Research Ethics Service Committee South Central—Oxford B via the Integrated Research Application System (reference number 14/SC/1369). Results of this study will be disseminated through peer-reviewed publications and scientific presentation

Prospects of fortification of salt with iron and iodine

Fortification of salt with iron has been developed by the National Institute of Nutrition (NIN) as a strategy for the control of iron deficiency anaemia (IDA) in India, similar to iodization of salt for control of iodine deficiency disorders (IDD). Stability of the iron fortified salt (IFS), its bioavailability and organoleptic evaluation of food items containing the IFS have been demonstrated. Acceptability and effectiveness of the IFS in school children and in multicentric community trials have been demonstrated. With the introduction of universal iodization of salt as a national policy in 1988, NIN has developed a formulation for double fortification (DFS) of salt with iodine and iron. The stability of the nutrients under laboratory conditions along with their bioavailability were found to be good but varying with the quality of salt used. The DFS has been evaluated in controlled trials in tribal communities and in residential school children. The findings of these studies are discussed. Overall, in these trials, DFS effectively controlled iodine deficiency but a clear impact on reducing anaemia was not demonstrated. In residential schoolchildren, increased urinary excretion of iodine as well as reduced anaemia were observed. The quality of salt has been found to be an important determinant of the stability of iodine in DFS. Further evaluation of this potentially important intervention is in progress

Effect of micronutrient supplement on health and nutritional status of schoolchildren: study design

Objective We tested the hypothesis that supplementation with a micronutrient-fortified beverage improves micronutrient status and physical and mental development in apparently healthy schoolchildren. Methods The study was carried out in middle-income students in two residential schools that catered to children from a semi-urban population near Hyderabad, India. Included were 869 children who were 6 to 16 y of age in grades 1 to 10. Because children at each grade were distributed across two classrooms (clusters) and were homogeneous, each grade was considered to consist of a matched pair. There were thus 10 pairs available for the study. Classes in each grade were randomized to receive a micronutrient-enriched beverage or a placebo without added micronutrients. The study was double blinded and the duration was 14 mo, with supervised feeding of the micronutrient-enriched beverage. The effect of the micronutrients on the outcome variables growth, biochemical status, mental function, and bone health were assessed. Results The number of matched pairs varied between seven and eight, and the required number of children per treatment group ranged from 32 in the case of bone heath to 177 for body weight. The power of the outcome variables ranged from 74% to 100% and was adequate for successful pairing. The effect assessed at the end of supplementation showed that the intervention was beneficial. Conclusions Designing an intervention, choosing outcome variables, and implementing the protocol in a typical Indian school setting were achieved

4 Gy versus 24 Gy radiotherapy for follicular and marginal zone lymphoma (FoRT):long-term follow-up of a multicentre, randomised, phase 3, non-inferiority trial

BACKGROUND: The optimal radiotherapy dose for indolent non-Hodgkin lymphoma is uncertain. We aimed to compare 24 Gy in 12 fractions (representing the standard of care) with 4 Gy in two fractions (low-dose radiation). METHODS: FoRT (Follicular Radiotherapy Trial) is a randomised, multicentre, phase 3, non-inferiority trial at 43 study centres in the UK. We enrolled patients (aged >18 years) with indolent non-Hodgkin lymphoma who had histological confirmation of follicular lymphoma or marginal zone lymphoma requiring radical or palliative radiotherapy. No limit on performance status was stipulated, and previous chemotherapy or radiotherapy to another site was permitted. Radiotherapy target sites were randomly allocated (1:1) either 24 Gy in 12 fractions or 4 Gy in two fractions using minimisation and stratified by histology, treatment intent, and study centre. Randomisation was centralised through the Cancer Research UK and University College London Cancer Trials Centre. Patients, treating clinicians, and investigators were not masked to random assignments. The primary endpoint was time to local progression in the irradiated volume based on clinical and radiological evaluation and analysed on an intention-to-treat basis. The non-inferiority threshold aimed to exclude the chance that 4 Gy was more than 10% inferior to 24 Gy in terms of local control at 2 years (HR 1·37). Safety (in terms of adverse events) was analysed in patients who received any radiotherapy and who returned an adverse event form. FoRT is registered with ClinicalTrials.gov, NCT00310167, and the ISRCTN Registry, ISRCTN65687530, and this report represents the long-term follow-up. FINDINGS: Between April 7, 2006, and June 8, 2011, 614 target sites in 548 patients were randomly assigned either 24 Gy in 12 fractions (n=299) or 4 Gy in two fractions (n=315). At a median follow-up of 73·8 months (IQR 61·9-88·0), 117 local progression events were recorded, 27 in the 24 Gy group and 90 in the 4 Gy group. The 2-year local progression-free rate was 94·1% (95% CI 90·6-96·4) after 24 Gy and 79·8% (74·8-83·9) after 4 Gy; corresponding rates at 5 years were 89·9% (85·5-93·1) after 24 Gy and 70·4% (64·7-75·4) after 4 Gy (hazard ratio 3·46, 95% CI 2·25-5·33; p<0·0001). The difference at 2 years remains outside the non-inferiority margin of 10% at -13·0% (95% CI -21·7 to -6·9). The most common events at week 12 were alopecia (19 [7%] of 287 sites with 24 Gy vs six [2%] of 301 sites with 4 Gy), dry mouth (11 [4%] vs five [2%]), fatigue (seven [2%] vs five [2%]), mucositis (seven [2%] vs three [1%]), and pain (seven [2%] vs two [1%]). No treatment-related deaths were reported. INTERPRETATION: Our findings at 5 years show that the optimal radiotherapy dose for indolent lymphoma is 24 Gy in 12 fractions when durable local control is the aim of treatment. FUNDING: Cancer Research UK