Indians' craving for salt leading to a rising number of strokes in country



Restricting It Must Be Part Of Policy Planning, Say Docs

Almost 1.65 million people across the world die due to heart problems brought on by excess intake of salt, said a research analyzing populations from 187 countries.

The paper, published in the New England Journal of Medicine (NEJM) on Thursday, found that the average consumption of salt across the globe was 3.95gm per day , nearly double the 2gm recommended by the World Health Organization.

A separate Indian study released a few days ago--the INDIAB study of the Indian Council for Medical Research--found that the mean salt intake in urban India was 7.6gm per day , much higher than the global mean.

"It is well known that salt or sodium is a risk factor for heart disease and stroke," said endocrinologist Dr Shashank Joshi, one of the lead authors of the INDIAB study .
Considering that one in four Indian adults suffers from high blood pressure, one can gauge the extent of heart problems caused by salt.

The highlight of NEJM's study , conducted by a 100-member team of academicians led by Tufts University , is that it's the first to quantify the effect of excess sodium on cardiovascular diseases. The final conclusion was that in 2010 alone, around 1.65 million across the world suffered fatal heart problems aggravated by their high sodium intake.

To arrive at the conclusion, the study--funded by the Bill & Melinda Gates Foundation--analyzed existing data from 205 surveys of sodium intake in 66 countries. The effects of sodium on blood pressure and of blood pressure on cardiovascular diseases were determined separately . The researchers then combined these findings with the current rates of cardiovascular diseases around 187 countries to estimate the number of cardiovascular deaths attributable to sodium consumption above 2gm per day .

"This important study reiterates that excess salt intake is equivalent to tobacco intake in terms of human disease and death. India ranks high on the list of countries with excess salt intake and resultant cardiovascular disease and deaths," said senior Delhi-based endocrinologist Dr Anoop Misra. He felt that a reduction in salt intake is not possible without legal restrictions and policy changes. "Salt restriction should be at the top of health policy planning to contain hypertension and heart disease," he added.

The INDIAB study on the prevalence of diabetes and hypertension in India published two weeks ago found that Indians have a "salt-preponderance". "We crave salt. We not only reach for packed namkeen stuff and dishes high on salt, we also take hidden salt in pickles, papads, etc," said Joshi.

The explosion of hypertension in the country is higher than diabetes.
"The number of Indians suffering stroke is rising. One of the causes is our high salt intake," said Joshi.

The NEJM study found that four out of five global deaths attributable to higher than recommended sodium intakes occurred in middleand low-income countries. The research team also said the 1.65 million deaths meant that nearly one in 10 of all deaths from cardiovascular causes worldwide was due to higher salt ingestion. It concluded that strong policies are needed to reduce dietary sodium across the world.

Maha On Sodium High The INDIAB study of the Indian Council of Medical Research (ICMR) released data last fortnight, showing the mean salt intake in urban areas was significantly higher than that in the rural areas (7.6gm per day against 6.8gm per day).

The mean salt intake was highest in Chandigarh (8.3gm per day), followed by Maharashtra (7.2gm per day), Tamil Nadu (6.8gm per day) and Jharkhand (5.9gm per day).





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Best way to brush? Even dentists disagree





Brushing our teeth — we all do it, once in the morning, once before bedtime. And we all think we know the best technique.

However, it would seem that after all we don't and, more worryingly, neither do our dentists nor do the people who make our toothbrushes.

A new study, by dental experts at University College London, has condemned "unacceptably inconsistent" advice from national dental associations, manufacturers and dentists themselves on the simple matter of brushing teeth.

Across 10 countries, researchers identified no fewer than six basic methods of brushing, and a variety of advice on the important aspects of dental hygiene: how often to brush, how long to brush for, technique and ways of rinsing.

The authors said there appeared to be "no consensus among professional bodies on the best method of toothbrushing for the general population or for people of different ages or with particular dental conditions. Such diversity in recommendations should be of serious concern to the dental profession".

Dr Nigel Carter of the British Dental Health Foundation admitted that experts "struggle" over toothbrushing recommendations. "When you actually look at the science there is no clear evidence around what method might be best, and the recommendations on toothbrushing intervals also vary hugely around the world," he said.

In the UK for instance, widely followed advice says to brush for two minutes twice a day. But many countries recommend three minutes, while most South American countries advise brushing for one minute, three times a day.

"I think the toothbrush manufacturers have been guilty of not doing as much research as they might," said Dr Carter. "Hopefully what [the UCL study] will do will focus some scientists on doing some more robust research on both the various techniques of brushing and the brushing intervals."

The most-commonly recommended method is known as the modified bass -which involves horizontal brush movements, accompanied by vertical and sweeping motions to create circles. However, no large studies have been carried out to determine whether it is really more effective than other simpler methods — including the most basic scrub technique taught to children.

Dr John Wainwright, the study's lead author and a practising dentist, said that he often encountered patients concerned that his recommendations differed to what previous dentists had told them.

"What I feel we need is better research into what the easiest to learn, most effective and safest way to brush is," he said.

"The current situation where not just individual dentists, but different dental organisations worldwide are all issuing different brushing guidelines isn't just confusing — it's undermining faith and trust in the profession as a whole. For something most people do twice a day, you would expect dentists to send a clearer, more unified message t o t h e i r p a t i e n t s o n how to brush their teeth."

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Insurance claim's rejection due to `delay' not alright





`Treatment Went On For A Yr After Hospitalization'

A consumer forum has ruled in favour of a woman whose insurance claim was rejected by her insurer because it was filed 416 days after hospitalization instead of within the 30-day deadline.

The forum found that the complainant was under continuous treatment for her injury for more than a year.

It recently chastised National Insurance Co Ltd for repudiating the claim on technical grounds that "cannot be held as just and proper". "The insurance company adopted (an) unfair trade practice," said the South Mumbai District Consumer Disputes Redressal Forum, while directing the firm to pay Worli-based Jyoti Raut the insurance amount of Rs 39,439 along with compensation of Rs 12,000.

Raut was admitted in hospital on February 9, 2010, after she had a fall. When she was discharged the next day, Raut informed the insurer about the fall and the need for hospitalization and requested it for a claim form. She alerted it that as her treatment was on-going she would file the claim upon its completion. This point was iterated in letters on March 9, 2010, and March 7, 2011.

On April 25, 2011, Raut sent a letter claiming expenses incurred on the treatment that continued till March 31, 2011.

Two months later, however, the company repudiated the claim on the ground that the papers were not submitted within 30 days from the completion of the hospital treatment.

Raut lodged many protests with the insurer but when they were ignored she filed a complaint before the forum on July 11, 2012. The insurer, in response, argued there was no evidence to prove her continuous treatment till March 2011. "The last receipt of the doctor's clinic is dated September 9, 2010. It shows the treatment was completed," the company claimed.

The forum however pointed to bills showing that Raut had purchased medicines "on doctor's advice" on five different dates till February 2011.

"The evidence shows the complainant was under treatment till the end of March 2011 and that she incurred an expenditure of Rs 39,439 on treatment," it said.

It observed that Raut had informed the insurer that the doctor had advised her to continue treatment till March 2011. Thus, "it cannot be said that there was delay in submitting the claim on the part of the complainant," the forum said.





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