Monday, September 29, 2008

Pediatric obesity - some guidelines

Photos and all italics were added by me to explain the meaning of certain words and phrases.

The Endocrine Society (read about The Endocrine Society) has issued practice guidelines for the prevention and treatment of pediatric obesity. The online version was released on 9 September.

Recommendations set forth in the guidelines are as follows:

  • Overweight is defined as a body mass index (BMI) in the 85th percentile or greater, but less than the 95th percentile, and obesity as a BMI in the 95th percentile or greater.
    BMI Categories for Kids:
    Underweight - BMI less than the 5th percentile
    Healthy Weight - BMI 5th percentile up to the 85th percentile
    Overweight - BMI 85th to less than the 95th percentile
    Obese - BMI greater than or equal to the 95th percentile.
    Refer to BMI chart for girls
    here, and for boys here

  • If there is evidence of a genetic syndrome (syndrome = a group of symptoms or identifying features of a disorder or disease; genetics syndrome = a syndrome presented by abnormalities in development and/or growth, which is caused by defects in genes and chromosomes) , referral to a geneticist is indicated.
    Children with a BMI in the 85th percentile or greater should be evaluated for obesity-associated comorbidities (other underlying or co-existing illness/health conditions).
  • As the prerequisite for any treatment, intensive lifestyle modification should be prescribed and supported, including dietary, physical activity, and behavioral components.
  • Dietary recommendations include avoiding consumption of calorie-dense, nutrient-poor foods (eg, sweetened beverages, most "fast food," and calorie-dense snacks); controlling energy intake through portion control in accordance with the Guidelines of the American Academy of Pediatrics; reducing saturated dietary fat intake for children older than 2 years; increasing intake of dietary fiber, fruits, and vegetables; eating timely, regular meals, particularly breakfast; and avoiding constant "grazing," especially after school.

Suggestions set forth in the guidelines are as follows:

  • Pharmacotherapy (treatment with drugs), in addition to lifestyle modification, should be considered in obese children only when intensive lifestyle modification has been ineffective and in overweight children only if severe comorbidities persist despite intensive lifestyle modification, especially those children who have a strong family history of type 2 diabetes or premature cardiovascular disease.
    Pharmacotherapy should be prescribed only by clinicians experienced in using antiobesity agents who are cognizant of the risks for adverse reactions.
    Pharmacotherapeutic options may include: i) sibutramine, which is not approved by the US Food and Drug Administration (FDA) for those younger than 16 years; ii) orlistat, which is not FDA approved for those younger than 12 years; iii) metformin, which is not FDA approved for treatment of obesity but which is approved for those who are at least 10 years old with type 2 diabetes mellitus; iv) octreotide, which is not FDA approved for the treatment of obesity; v) leptin, which is not FDA approved; vi)topiramate, which is not FDA approved for the treatment of obesity; - growth hormone, which is not FDA approved for the treatment of obesity.
  • Bariatric surgery, which refers to surgical procedures performed to treat obesity by modification of the gastrointestinal tract to reduce nutrient intake and/or absorption, is suggested for adolescents with a BMI of less than 50 kg/m2, or more than 40 kg/m2 in whom lifestyle modifications and/or pharmacotherapy have been unsuccessful and who have severe comorbidities. (more about bariatric surgery from Wikipedia).

  • Bariatric surgery is not recommended for preadolescent children; for pregnant or breast-feeding adolescents; for those planning to become pregnant within 2 years of surgery; for any patient who has not mastered the principles of healthy dietary and activity habits; or for any patient with an unresolved eating disorder, untreated psychiatric disorder, or Prader-Willi syndrome (read more about Prader-Willi Syndrome here).

  • To help prevent obesity, clinicians should recommend that infants be breast-fed for at least 6 months and that schools offer children in all grades 60 minutes of moderate to vigorous daily exercise.

  • Clinicians should educate children and parents regarding healthy dietary and activity habits; advocate to restrict availability of unhealthy food choices in schools; ban advertising promoting unhealthy food choices to children; and redesign communities in ways that will maximize opportunities for safe walking and bike riding to school, athletic activities, and neighborhood shopping.

"The objective of interventions in overweight and obese children and adolescents is the prevention or amelioration of obesity-related co-morbidities, e.g., glucose intolerance and T2DM [type 2 diabetes mellitus], metabolic syndrome, dyslipidemia, and hypertension," the authors of the guidelines write. "We suggest that pharmacotherapy (in combination with lifestyle modification) be considered if a formal program of intensive lifestyle modification has failed to limit weight gain or to mollify comorbidities in obese children. Overweight children should not be treated with pharmacotherapeutic agents unless significant, severe co-morbidities persist despite intensive lifestyle modification."
-Journal of Clinical Endocrinology & Metabolism-


Wednesday, September 24, 2008

The China tainted milk story - what actually happened

China’s milk scandal bares government failures

At least 10 nations are now banning Chinese dairy products

Updated 10:30 am 25/09/08

BEIJING - The note posted in July on the Web site of China’s food safety inspection agency came from a doctor: There had been a sudden rise in infants turning up at his hospital with kidney stones after drinking the same brand of formula.
The warning, which urged an investigation, went unheeded. In the two weeks since China began piecemeal reporting about contamination of the milk supply, a picture has emerged of official indifference, greed and government dysfunction.
Among the startling details: the practice of adulterating milk was widely known in the industry, and one dairy knew since late last year that its formula was sickening children. The revelations have dismayed a broad segment of the public — parents — who feel the government has breached their trust. Tens of thousands of children have sought medical care, nearly 13,000 have been hospitalized and four infants have died.
'We trusted the government'“I’m just disappointed because the government should have done more to protect its citizens,” said Liao Yanfang, a migrant worker whose 1-year-old son was found to have kidney stones Tuesday at Beijing Children’s Hospital. Since birth, her only child had been drinking infant formula made by the company at the center of the scandal, Sanlu Group Co., she said.
“I fed my baby powdered milk because ads said it was more nutritious than breast milk. We trusted that the government would provide adequate tests to ensure food quality,” she said.
In the past two weeks, Beijing has recalled a broad array of milk products — all tainted by the industrial chemical melamine — and arrested Sanlu’s chairwoman and several suppliers. It has dismissed officials and offered free medical care to the afflicted. “Nothing like this will ever happen again,” Premier Wen Jiabao pledged. But questions remain about why food and health inspectors ignored growing signs of trouble in the milk supply and when the communist leadership knew about it. Galling to many Chinese is the suspicion that high-level pressures for a successful Beijing Olympics added momentum for a cover-up.
“The dairy products for the Olympic Games were safe. I think the inspection agency already knew about it, and they tried to protect the ’national brand,”’ said Zhou Ze, a law professor at China Youth University For Political Science.
Regaining the confidence of the Chinese public and the world is likely to take concerted doing. The scandal has battered the government’s image, so carefully cultivated during the Olympics.
Governments heavily courted by Beijing have sounded the alarm. Normally pro-China Singapore has banned the sale and import of Chinese dairy products, from yogurt to candy. At least nine other countries have done the same.
Other nations, from Canada to Australia, have increased testing of Chinese food imports. The European Union ordered customs inspectors Tuesday to be on alert for products such as bread or chocolate to insure they contain no contaminated milk.
In the U.S., the Food and Drug Administration expanded its sampling of imports from Asia to include dairy-based candies and desserts. Over the weekend, the agency announced it had started checking imports of bulk food ingredients, including milk powder, whey and some milk-derived proteins. No tainted products from China have turned up.
The overall impression is of an authoritarian government struggling to enforce its writ on a rapidly developing country where officials and businesses often go their own way.
Just four years ago, Premier Wen issued an apology and promised greater transparency when official cover-ups aided the spread of SARS from China to the world. Last year, after exported pet food, cough medicine, toothpaste and toys made with toxic products sickened and killed pets and people in North and South America, the government promised to overhaul safety inspection regimes.
“Although after SARS, the government promised a more open media environment and to protect people’s right of expression, without essential measures, it’s just empty talk. What is really needed is to change the system’s framework,” said Yang Fengchun of Peking University’s School of Government. “The government and companies have lied to people, so it becomes very difficult to make people believe again in what they say.”
This time around, promises of official oversight fell flat in the boisterously growing dairy industry. Almost nonexistent two decades ago, the industry has boomed, transforming once scarce milk and milk powder into staples that have boosted nutritional levels and health from the urban middle class to the rural poor. Unlike the United States, where dairies run farms with thousands of cows and are better able to control quality, milk in China comes from a patchwork of producers. Most are small farms with just a few cows who sell the raw milk to collection stations, which in turn sell mainly to giant dairy processing companies.
“The middleman is where the system breaks down totally,” said David Oliver, a New Zealander who is a dairy industry consultant in Beijing.
Two giant processing companies — Mengniu Dairy Group Co. and Yili Industrial Group Co. — control nearly 60 percent of the total market for milk, yogurt and other dairy products, according to Beijing Orient Agribusiness Consultant Co. But in the past three years, prices for feed, fuel and other costs rose — feed by as much as 30 percent. Further pressures came last year when Beijing enacted price controls to tame double-digit inflation for food.
Milk collectors found themselves squeezed between the farmers asking for more money and the processors who demanded that prices be held down, said Chen Lianfang of Orient Agribusiness.
That squeeze gave suppliers incentives to tamper with the raw milk, watering it down and then adding ingredients, said Chen.
Melamine, a relatively cheap binding agent used in plastics and as a flame retardant, is rich in nitrogen, fooling widely used tests that check for protein. When mixed with formaldehyde, it dissolves in water.
In the wake of the scandal, inspectors found melamine in products from Yili, Mengniu, Sanlu and 19 other dairy companies.
Government officials have painted the middlemen as the main villains. A vice governor of Hebei province, where Sanlu is located, said one of the dairy’s suppliers began using melamine three years ago.
Chinese health officials have said no harm comes from consuming tiny amounts of melamine, less than 0.63 milligrams per kilogram. But some of Sanlu’s infant formula contained up to 4,000 times that amount, as much as 25 milligrams per kilogram.
Trouble with Sanlu’s products began brewing last December, with parents complaining to the company about infants sickened by formula, Chinese state television said. Sanlu bought off one complainer with free milk products. Doctors and reporters also sounded warnings.
At an editorial meeting at one state-run newspaper last week, editors were told that its Hebei-based reporter wrote an “internal reference” sent to Beijing in March about contamination of Sanlu products, said two participants. They requested their names and that of their newspaper not be used for fear of retribution by officials.
A pediatric urologist, Feng Dongchuan, said in a posting July 24 on his online journal that he had treated seven infants for kidney stones at the Pediatric Hospital in the central city of Xuzhou, an unusually high number.
“Coincidentally all consumed a certain famous domestic brand of formula,” Feng wrote. He said more cases were reported in nearby Nanjing.
That day a urologist who would not give his name sent a similar warning to the General Administration of Quality Supervision, Inspection and Quarantine, naming the brand of formula — Sanlu.
The reply, posted a week later, said: “Please report this problem to the health departments.”
Meanwhile, Sanlu was quietly ordering distributors to remove milk powder and infant formula, distributors said. China Central Television said Sanlu knew in June that tests had detected melamine.
At board meetings in the Hebei capital of Shijiazhuang on Aug. 2 and again on Aug. 9, Sanlu executives were confronted by the dairy’s New Zealand investor, the Fonterra cooperative, which urged them to go public. Company executives and local government officials refused.
The central government said it only learned of the scandal Sept. 8 — it does not say how — even though inspection, health and other government departments in Hebei and Beijing knew earlier.

-2008 The Associated Press

KKM's press release 24/09/08

KENYATAAN AKHBAR KE LIMA SUSU DAN HASILAN SUSU DARI CHINA YANG TERCEMAR DENGAN MELAMINE
Kementerian Kesihatan Malaysia (KKM) ingin memaklumkan maklumat terkini berkaitan dengan isu susu dan hasilan susu dari China yang tercemar dengan melamine.Senarai produk makanan yang tidak terlibat dengan isu melamine dari China telah dikemaskini sehingga hari ini adalah seperti di Lampiran 1.KKM telah menjalankan pemeriksaan dan penyitaan bagi produk-produk hasilan susu di seluruh negara bermula semalam. Setakat ini, laporan penyitaan yang telah dijalankan di pasaran tempatan seperti di Lampiran 2.KKM juga telah mendapatkan kerjasama Kementerian Pelajaran Malaysia (KPM) untuk memastikan semua kantin sekolah tidak menjual produk makanan yang disyaki tercemar oleh melamine dari Negara China.Di pintu masuk negara, KKM dengan kerjasama pihak Kastam Diraja Malaysia (KDRM) memastikan produk yang telah diarah untuk Pemeriksaan Tahap 6 (Auto Rejection) tidak akan masuk ke negara ini. Sehubungan dengan produk-produk makanan lain dari Negara China, KKM telah mengenakan Pemeriksaan Tahap 5 (Tahan, Uji & 1Lepas) untuk memastikan keselamatan makanan tersebut. Di samping itu, aktiviti pemantauan produk makanan akan dijalankan secara berterusan.Sekiranya pengguna telah mengambil sebarang produk makanan yang disyaki tercemar dengan melamine, pengguna dinasihatkan supaya tidak bimbang kerana kesannya sangat sedikit sebab memerlukan kandungan melamine yang banyak. European Commission Directive EC No. 2002/72 telah menetapkan tahap migrasi melamine yang selamat daripada bekas / pembungkus kepada makanan ialah 30 mg / kg makanan. Dalam konteks ini, melamine telah dikesan di dalam minuman, kopi, jus oren, susu fermentasi dalam julat 0.54 – 2.2 mg / kg makanan.Jika pengguna masih ragu-ragu mengenai tanda-tanda kegagalan ginjal, mereka hendaklah segera berjumpa dengan pegawai perubatan untuk mendapatkan sebarang nasihat dan rawatan yang berkaitan.
Kementerian Kesihatan Malaysia
24 September 2008




The Ministry Of Health Malaysia has started a Melamine operation room. The operation room details:

FSQD MELAMINE OPERATION ROOM

Operation room is opened from 8.00 am till 5.00 pm (office hour) everyday including on public holidays.
Any assistants or enquiries, please contact these numbers :
Tel : 03 - 8883 3655 & 03 - 8883 3503
Email : kkm@moh.gov.my

For more information on the list of banned & safe products in Malaysia, Q&As and latest press release, you can access the MOH site here or Food & Safety Quality Division here.

Tuesday, September 16, 2008

A nation lacking basic hygiene

Dirtiest among seven nations, the title read.

NST
Online yesterday posted an article on it's front page yesterday regarding a recent hygiene survey done on seven countries, including Malaysia. The article continued...

"KUALA LUMPUR: Would you cook in your toilet? If hygiene is your primary concern, you might consider doing so.
A recent seven-country survey conducted by the Hygiene Council, a global panel of medical experts, found that Malaysian kitchens were more bacteria-infested than bathrooms.With dishcloths and kitchen sinks crawling with germs found in faeces, it is not only great food that's being cooked in our kitchens. Disease and infection are stewing there as well. Overall, Malaysian homes were found to be the dirtiest among all the countries studied, right after India. The cleanest abodes were found in Saudi Arabia..."

You can read the whole article here.

What got me even more worried is the fact that this survey was done in homes ( and 70% of the samples were highly contaminated with E.coli, a kind of bacteria found in human faeces).

Now, what do you think the outcome of this survey would have been like if it was carried out on our eateries outside. Most probably the finding would have been published in an article entitled "Malaysians eating shit at outside eateries".

So, Malaysians please, please give some priority to personal hygiene.

1)Please make sure you wash your hands with soap after using the toilet, even if you just took a leak. But, sadly, in Malaysia, the public toilets are a far cry from the word clean! Most of them don't even have running water, leave alone soap!

2) Please wash your hands with soap before eating, even if you had just washed your hands 10 minutes ago...or you might just end up eating shit!

3) Please make sure your children take a bath and clean themselves up after coming home from school. Do not allow them to touch anything in the kitchen, fridge or dining area unless they've at least washed their hands with soap.

4) Please make sure your maids and those babysitters wash their hands with soap as above and after changing your child's diaper. Also please make sure diapers are disposed off properly.

Here's a chart to show you the proper way to wash your hands.