Advertisements
Feeds:
Posts
Comments

Posts Tagged ‘sulfur/nitrogen ratio’


Is Malnutrition the Cost of Civilization?

Curation: Larry H. Bernstein, MD, FCAP

 

 

This topic is an extension of more than 30 years interest in nutrition, mainly, but not only protein-energy malnutrition. The field of biochemistry and enzymology that concerns intermediary metabolism has a relationship to the processes  of the living cell and organisms, and precedes the evolution of molecular biology and genomics.  However, the global importance of nutrition, food sources and water supplies has not retreated despite extensive knowledge about nutrition, improvements in agriculture,   and the evolution of food science. The insurmountable problem is the long global history of centuries of european colonialization and more recent post WWII hegemeny, repeated wars, the decay of states, rural and/or urban poverty, and mass migrations. These have much to do about environment and of economic disparities that make continuation of the current situation unsustainable as exists.  The solutions are both economic and political.

I shall divide this presentation into the following parts:

  1. What is malnutrition?
  2. How is malnutrition distributed among countries around the globe?
  3. The significant burden of childhood malnutrition and stunting.
  4. The good, the bad and the ugly of sulfur and volcanic activity.
  5. The relationship of S amino acids to marasmic and kwashiorkor PEM.
  6. The biochemistry of S amino acids.
  7. The relationship of stress hypermetabolism to essential protein needs.
  8. The relationship of PEM to stature and to brain development.
  9. Nutrition and aging.

The Malady and its Distribution

What is Malnutrition?

Simply put malnutrition is the long term deficiency of necessary nutrients for life or for long term growth and maintenance. There are two major types of malnutrition.  We have a long history of the discovery of the elements of the periodic table, a number of which are essential for anionic and cationic activity, and metal ligands (iron), and of the vitamins, essential for cofactors and involved in enzymatic reactions.  These are called micronutrients.  They are not the subject of these discussions. We concern ourselves here with macronutrient deficiency, such as carbohydrate, protein and fat.  Carbohydrate is fuel for short term energy and for structure, and fat is used for long term energy and structure.  In this case I call attention to essential proteins, which may also bind to carbohydrate or to lipid in membrane structure.  This major nutritional class is called protein-energy malnutrition, which exists as marasmus or as kwashiorkor, the latter of which exhibits edema and wasting. Edema may occur at a serum albumin concentration less than 2.8 mg/dl, at which water accumulates in the interstitial tissues, and in severely malnourished children accumulates in the peritoneal cavity. Serious protein-energy malnutrition (PEM) can result in death, either from sufficient loss of lean body mass, or from comorbidity of infection, septicemia, or organ failure, and may have anemia, congestive heart failure, pulmonary edema, or viral or parasitic infection as comorbidity. On a global scale, PEM is most common in children under age 5-6 years age, and it is accompanied by stunting (growth failure) and mental retardation.  PEM in urban or rural areas is associated with high poverty rates and in some regions with waste water contamination, and in other circumstances a lack of dietary animal protein from milk at birth, and later from lack of milk, eggs, chicken, fish, or meat intake by a vegan diet.

Water-related diseases

Malnutrition

Malnutrition is a major health problem, especially in developing countries. Water supply, sanitation and hygiene, given their direct impact on infectious disease, especially diarrhoea, are important for preventing malnutrition. Both malnutrition and inadequate water supply and sanitation are linked to poverty. The impact of repeated or persistent diarrhoea on nutrition-related poverty and the effect of malnutrition on susceptibility to infectious diarrhoea are reinforcing elements of the same vicious circle, especially amongst children in developing countries.

The disease and how it affects people

Malnutrition essentially means “bad nourishment”. It concerns not enough as well as too much food, the wrong types of food, and the body’s response to a wide range of infections that result in malabsorption of nutrients or the inability to use nutrients properly to maintain health. Clinically, malnutrition is characterized by inadequate or excess intake of protein, energy, and micronutrients such as vitamins, and the frequent infections and disorders that result.

People are malnourished if they are unable to utilize fully the food they eat, for example due to diarrhoea or other illnesses (secondary malnutrition), if they consume too many calories (overnutrition), or if their diet does not provide adequate calories and protein for growth and maintenance (undernutrition or protein-energy malnutrition).

Malnutrition in all its forms increases the risk of disease and early death. Protein-energy malnutrition, for example, plays a major role in half of all under-five deaths each year in developing countries (WHO 2000). Severe forms of malnutrition include marasmus (chronic wasting of fat, muscle and other tissues); cretinism and irreversible brain damage due to iodine deficiency; and blindness and increased risk of infection and death from vitamin A deficiency.

Nutritional status is compromised where people are exposed to high levels of infection due to unsafe and insufficient water supply and inadequate sanitation. In secondary malnutrition, people suffering from diarrhoea will not benefit fully from food because frequent stools prevents adequate absorption of nutrients. Moreover, those who are already experiencing protein-energy malnutrition are more susceptible to, and less able to recover from, infectious diseases.

The cause

Individual nutritional status depends on the interaction between food that is eaten, the overall state of health and the physical environment. Malnutrition is both a medical and a social disorder, often rooted in poverty. Combined with poverty, malnutrition contributes to a downward spiral that is fuelled by an increased burden of disease, stunted development and reduced ability to work.

Poor water and sanitation are important determinants in this connection, but sometimes improvements do not benefit the entire population, for example where only the wealthy can afford better drinking-water supplies or where irrigation is used to produce export crops. Civil conflicts and wars, by damaging water infrastructure and contaminating supplies, contribute to increased malnutrition.

Scope of the Problem

Chronic food deficits affect about 792 million people in the world (FAO 2000), including 20% of the population in developing countries. Worldwide, malnutrition affects one in three people and each of its major forms dwarfs most other diseases globally (WHO, 2000). Malnutrition affects all age groups, but it is especially common among the poor and those with inadequate access to health education and to clean water and good sanitation. More than 70% of children with protein-energy malnutrition live in Asia, 26% live in Africa, and 4% in Latin America and the Caribbean (WHO 2000).

Interventions

Interventions that contribute to preventing malnutrition include :

  • Improved water supply, sanitation and hygiene.
  • Health education for a healthy diet.
  • Improved access, by the poor, to adequate amounts of healthy food.
  • Ensuring that industrial and agricultural development do not result in increased malnutrition.

References

WHO. Turning the tide of malnutrition: responding to the challenge of the 21st century. Geneva: WHO, 2000 (WHO/NHD/00.7)

FAO. The state of food insecurity in the world 2000 (FAO, Rome)

See also WHO web site on nutrition

Prepared for World Water Day 2001. Reviewed by staff and experts from the Department of Nutrition for Health and Development and the Water, Sanitation and Health Unit, World Health Organization (WHO).

 

 2015 World Hunger and Poverty Facts and Statistics

http://www.worldhunger.org/articles/Learn/world%20hunger%20facts%202002.htm

Protein is necessary for key body functions including provision of essential amino acids and  development and maintenance of muscles. Protein-energy malnutriton is the more lethal form of malnutrition/hunger and is the type of malnutrition that is referred to when world hunger is discussed.  This leads to growth failure.  Principal types of growth failure are:

  • The two types of acute malnutrition are wasting (also called marasmus) or nutritional edema, (also called kwashiorkor).  Wasting is characterised by rapid weight loss and in its severe form can lead to death. Nutritional edema is caused by insufficient protein in the diet. See visual illustrations here.
    .
  • Stunting is a slow, cumulative process and is caused by insufficient intake of some nutrients. It is estimated by the United Nations Children’s Fund (UNICEF) to affect 161 million children  world wide  (UNICEF Nutrition).  Stunted children may have normal body proportions but look younger than their actual age. Stunting develops over a long period as a result of inadequate nutrition or repeated infections, or both.

The second type of malnutrition, also very important, is micronutrient (vitamin and mineral) deficiency. This is not the type of malnutrition that is referred to when world hunger is discussed, though it is certainly very important.

Number of hungry people in the world

The United Nations Food and Agriculture Organization estimates that about 805 million people of the 7.3 billion people in the world, or one in nine, were suffering from chronic undernourishment in 2012-2014. Almost all the hungry people, 791 million, live in developing countries, representing 13.5 percent, or one in eight, of the population of developing counties. There are 11 million people undernourished in developed countries (FAO 2014; for individual country estimates, see Annex 1. For other valuable sources, especially if interested in particular countries or regions, see IFPRI 2014 and Rosen 2014,).

  

A global distribution of PEM has been extensively studied by the World Health Organization for decades.  Here are some examples with maps of the global distribution of the disease.

Undernourishment around the world, 1990-2 to 2012-4
Number of undernourished and prevalence (%) of undernourishment

1990-2 No. 1990-2 % 2012-4 No. 2012-4 %
World 1,014.5 18.7 805.3 11.3
Developed regions 20.4 <5 14.6 <5
Developing regions 994.1 23.4 790.7 14.5
Africa 182.1 27.7 226.7 20.5
  Sub-Saharan Africa 176.0 33.3 214.1 23.8
Asia 742.6 23.7 525.6 12.7
  Eastern Asia 295.2 23.2 161.2 10.8
  South-Eastern Asia 138.0 30.7 63.5 10.3
  Southern Asia 291.7 24.0 276.4 15.8
Latin America & Carib. 68.5 15.3 37.0 6.1
Oceana 1.0 15.7 1.4 14.0

Source: FAO The State of Food Insecurity in the World 2014 p. 8

Does the world produce enough food to feed everyone?

The world produces enough food to feed everyone. For the world as a whole, per capita food availability has risen from about 2220 kcal/person/day in the early 1960s to 2790 kcal/person/day in 2006-08, while developing countries even recorded a leap from 1850 kcal/person/day to over 2640 kcal/person/day. This growth in food availability in conjunction with improved access to food helped reduce the percentage of chronically undernourished people in developing countries from 34 percent in the mid 1970s to just 15 percent three decades later. (FAO 2012, p. 4) The principal problem is that many people in the world still do not have sufficient income to purchase (or land to grow) enough food.

What are the causes of hunger?

What are the causes of hunger is a fundamental question, with varied answers.

Poverty is the principal cause of hunger. The causes of poverty include poor people’s lack of resources, an extremely unequal income distribution in the world and within specific countries, conflict, and hunger itself. As of 2015 (2011 statistics), the World Bank has estimated that there were just over 1 billion poor people in developing countries who live on $1.25 a day or less.  This compares with compared with 1.91 billion in 1990, and 1.93 billion in 1981.  This means that 17 percent of people in the developing world lived at or below $1.25 a day in 2011, down from 43 percent in 1990 and 52 percent in 1981.  (This compares with the FAO estimate above of  791 million people living in chronic undernourishment in developing countries.) Progress has been slower at higher poverty lines. In all, 2.2 billion people lived on less than US $2 a day in 2011, the average poverty line in developing countries and another common measurement of deep deprivation. That is only a slight decline from 2.59 billion in 1981. (World Bank Poverty Overview, World Bank2013).  Progress in poverty reduction has been concentrated in Asia, and especially, East Asia, with the major improvement occurring in China. In Sub-Saharan Africa, the number of people in extreme poverty has increased.  The statement that ‘poverty is the principal cause of hunger’  is, though correct, unsatisfying.  Why then are (so many) people poor?  The next sections summarize Hunger Notes’ answer.

Progress in reducing the number of hungry people

The vast majority of hungry people live in developing regions, which saw a 42 percent reduction in the prevalence of undernourished people between 1990–92 and 2012–14. Despite this progress, about one in eight people, or 13.5 percent of the overall population, remain chronically undernourished in these regions, down from 23.4 percent in 1990–92. As the most populous region in the world, Asia is home to two out of three of the world’s undernourished people.

  • There has been the least progress in the sub- Saharan region, where more than one in four people remain undernourished – the highest prevalence of any region in the world. Nevertheless, the prevalence of undernourishment in sub-Saharan Africa has declined from 33.3 percent in 1990– 92 to 23.8 percent in 2012–14, although the number of undernourished people has actually increased.
  • Hunger continues to take its largest toll in Southern Asia, which includes the countries of  India, Pakistan and Bangladesh. The estimate of 276 million chronically undernourished people in 2012–14 is only marginally lower than the number  in 1990– 92.   Eastern Asia (where China is by far the largest country) and South-eastern Asia (including Indonesia, Philippines, Mynamar, Vietnam and others) have reduced undernutriton substantially.
  • Latin America has the most successful developing region record in increasing food security.

The target set by the Millenium goals was to halve the proportion of hungry people by 2015.  For developing countries as a whole, the goal was to halve the proportion of hungry people from the base year(s) of 1990-2, or from 23.4% to ll.7%.  As the proportion in 2014–one year before the year the goals are supposed to be achieved–is 14.5%, the goal is unlikely to be met, although there has been significant reduction.  As can be seen from the table, East Asia, South East Asia, and Latin America and the Carribbean regions have met the goal.

Does the world produce enough food to feed everyone?

The world produces enough food to feed everyone. For the world as a whole, per capita food availability has risen from about 2220 kcal/person/day in the early 1960s to 2790 kcal/person/day in 2006-08, while developing countries even recorded a leap from 1850 kcal/person/day to over 2640 kcal/person/day. This growth in food availability in conjunction with improved access to food helped reduce the percentage of chronically undernourished people in developing countries from 34 percent in the mid 1970s to just 15 percent three decades later. (FAO 2012, p. 4) The principal problem is that many people in the world still do not have sufficient income to purchase (or land to grow) enough food.

What are the causes of hunger?

What are the causes of hunger is a fundamental question, with varied answers.

Poverty is the principal cause of hunger. The causes of poverty include poor people’s lack of resources, an extremely unequal income distribution in the world and within specific countries, conflict, and hunger itself. As of 2015 (2011 statistics), the World Bank has estimated that there were just over 1 billion poor people in developing countries who live on $1.25 a day or less.  This compares with compared with 1.91 billion in 1990, and 1.93 billion in 1981.  This means that 17 percent of people in the developing world lived at or below $1.25 a day in 2011, down from 43 percent in 1990 and 52 percent in 1981.  (This compares with the FAO estimate above of  791 million people living in chronic undernourishment in developing countries.) Progress has been slower at higher poverty lines. In all, 2.2 billion people lived on less than US $2 a day in 2011, the average poverty line in developing countries and another common measurement of deep deprivation. That is only a slight decline from 2.59 billion in 1981. (World Bank Poverty Overview, World Bank2013).  Progress in poverty reduction has been concentrated in Asia, and especially, East Asia, with the major improvement occurring in China. In Sub-Saharan Africa, the number of people in extreme poverty has increased.  The statement that ‘poverty is the principal cause of hunger’  is, though correct, unsatisfying.  Why then are (so many) people poor?  The next sections summarize Hunger Notes’ answer.

Harmful economic systems. Hunger Notes believes that a principal underlying cause of poverty and hunger is the ordinary operation of the economic and political systems in the world. Essentially control over resources and income is based on military, political, and economic power that typically ends up in the hands of a minority, who live well, while those at the bottom barely survive, if they do. We have described the operation of this system in more detail in our special section on Harmful economic systems

Conflict.  For 2012, the first and latest year for which its estimates are available, the Center for Research on the Epidemiology of Disasters (CRED) estimates that more than 172 million people were affected by conflict worldwide. Of this total 149 million or 87 percent were conflict-affected residents (CARs).  Internally displaced persons (IDPs) accounted for another 18 million and refugees for five million.  CRED says that the global total is higher because its figures only include 24 countries for which comparable and validated data are available.   CRED observes

  • Pakistan with 28 million and Nigeria with nearly 19 million had the largest numbers of people affected by conflict.
  • Libya and Somalia had the highest proportion of their populations affected by violence and insecurity at about 90 percent each.
  • IDPs suffer the worst health impacts of conflict.  They and their children are almost twice as likely as refugees to  die from conflict-related causes, particularly disease and starvation.
  • Conflict-affected residents also suffer significantly higher death rates than refugees (CRED 2013).

The estimated number of conflict-affected residents (172 million) represents 21 percent of the estimated number of undernourished people (805 million), which gives an approximate idea of the importance of conflict as a cause of hunger.

Hunger is also a cause of poverty, and thus of hunger. By causing poor health, small body size, low levels of energy, and reductions in mental functioning, hunger can lead to even greater poverty by reducing people’s ability to work and learn, thus leading to even greater hunger. See Victoria et al. 2008.

World population  A large world population does make it more difficult to provide a decent standard of living for all. Population growth rates have dropped substantially over the last 50 years.  See Population Reference Bureau 2014 for analysis of population trends.

Food and agricultural policy.  There certainly have been questions raised about the adequacy of food and agricultural policy throughout the world, especially their (lack of)  benefit to poor farmers.  For two souces that discuss these issues, see IFPRI 2014a and Institute for Development Studies HANCI.

Climate change. Climate change is increasingly viewed as a current and future cause of hunger and poverty. Increasing drought, flooding, and changing climatic patterns requiring a shift in crops and farming practices that may not be easily accomplished are three key issues.  Another key issue is the future of industrialization and higher standards of living, as the principal cause of climate change appears carbon dioxide produced by high energy use with industrialization and higher standards of living. See the Hunger Notes special report: Hunger, the environment, and climate change for further information, especially articles in the section: Climate change, global warming and the effect on poor people such as Global warming causes 300,000 deaths a year, study says and Could food shortages bring down civilization?

(Updated March 24, 2015)

 

India’s Worsening Water Crisis

114 million Indians will soon face desperate domestic, agricultural and industrial shortages borne of a water crisis.

http://thediplomat.com/2014/04/indias-worsening-water-crisis/

By Ram Mashru

In northern India, groundwater supplies are being depleted faster than natural processes can replenish them. According to The World Bank, India is the largest user of ground water in the world, after China. If something is not done soon, an estimated 114 million Indians will soon face desperate domestic, agricultural and industrial shortages.

What is causing this? “Human activities”: primarily wasteful water use (mainly agricultural over-exploitation), a lack of sustainable water-management policies and insufficient public investment. These failings have each been exacerbated by rapid population growth, increasing population density and climate change.

South Asia is a desperately water-insecure region, and India’s shortages are part of a wider continental crisis. According to a recent report authored by UN climate scientists, coastal areas in Asia will be among the worst affected by climate change. Hundreds of millions of people across East, Southeast and South Asia, the report concluded, will be affected by flooding, droughts, famine, increases in the costs of food and energy, and rising sea levels.

Groundwater serves as a vital buffer against the volatility of monsoon rains, and India’s falling water table therefore threatens catastrophe. 60 percent of north India’s irrigated agriculture is dependent on ground water, as is 85 percent of the region’s drinking water. The World Bank predicts that India only has 20 years before its aquifers will reach “critical condition” – when demand for water will outstrip supply – an eventuality that will devastate the region’s food security, economic growth and livelihoods.

delhi_districts

delhi_districts

ganges-river-map

ganges-river-map

How India’s subsidized farms have created a water crisis

America Abroad

http://www.pri.org/stories/2014-07-02/how-indias-subsidized-farms-have-created-water-crisis

http://cdn1.pri.org/sites/default/files/styles/story_main/public/story/images/IMG_5937.jpeg

tubewell

tubewell

Seedlings fed by a micro-irrigation system

Seedlings fed by a micro-irrigation system

planting rice

planting rice

tubewell

tubewell

paddy fields

paddy fields

 

 

 

 

 

 

 

 

Farm worker heading for the paddy fields at Gubinder Singh’s farm

 

 

 

South Asia is a desperately water-insecure region, and India’s shortages are part of a wider continental crisis. According to a recent report authored by UN climate scientists, coastal areas in Asia will be among the worst affected by climate change. Hundreds of millions of people across East, Southeast and South Asia, the report concluded, will be affected by flooding, droughts, famine, increases in the costs of food and energy, and rising sea levels.

The Indo-Gangetic Basin, which lies at the foothills of the Himalayas, is one of the areas in the world facing a huge water crisis.  The Basin spans from Pakistan, across Northern India into Bangladesh. Apart from runoff from mountainous streams and glaciers, it also holds one of the largest underground bodies of water in the world. But it’s also in one of the most populous regions of the world, with more than a billion people living on the subcontinent.  Still, parts of the region are well-resourced when it comes to water supplies – like the Indian state of Punjab, which has three rivers running through it and a network of canals in some parts.

But Punjab faces serious water shortages and a groundwater table that is falling dramatically. As in California, farmers have been tapping into groundwater supplies via tubewells. There are 1.3 million tubewells in the state, and officials say almost all farms have at least one. There are permits for 90,000 more wells awaiting approval. As a result, the water table is dropping by as much as a metre a year, particularly in the worst-affected regions in central and northern Punjab. It is an alarming figure, and one that has water experts around the world sitting up and taking notice.

Groundwater serves as a vital buffer against the volatility of monsoon rains, and India’s falling water table therefore threatens catastrophe. 60 percent of north India’s irrigated agriculture is dependent on ground water, as is 85 percent of the region’s drinking water. The World Bank predicts that India only has 20 years before its aquifers will reach “critical condition” – when demand for water will outstrip supply – an eventuality that will devastate the region’s food security, economic growth and livelihoods.

Analysts fear that growing competition for rapidly dwindling natural resources will trigger inter-state or intra-state conflict. China and India continue to draw on water sources that supply the wider region, and a particularly concerning flashpoint is the Indus River Valley basin that spans India and Pakistan. The river’s waters are vital to the economies of areas on both sides of the border and a long-standing treaty, agreed by Pakistan and India in 1960, governs rights of access. But during the “dry season,” between October and March, water levels fall to less than half of those seen during the remainder of the year. The fear is that cooperation over access to the Indus River will fray as shortages become more desperate.

Public health is also seriously at risk. The demand for safe drinking water in India is already high, and the situation will only grow more acute as levels drop further. The World Health Organization reports that 97 million Indians lack access to safe drinking water, while 21 percent of the country’s communicable diseases are transferred by the use of unclean water.

In their 2013 Outlook Report, the Asian Development Bank calculated India’s water security based on household, economic, urban and environmental needs, and concluded that India’s water prospects are “hazardous.” According to the report, a comprehensive and immediate program of investment, regulation, and law enforcement is necessary. Private-sector groups agree.

The 2030 Water Resources Group, made up of private companies, argues that the “water gap” (between insufficient supply and excess demand) in Asia will only close once countries limit the water-intensity of their economies. In Indian industry, dam construction for hydropower plants and large agribusiness landholdings account for the majority of the country’s water demands.

Parts of India have pioneered successful solutions. The southwestern state of Andhra Pradesh has introduced a highly effective program of self-regulatory water use. Community water-management schemes and awareness campaigns among farmers have seen levels of water consumption fall significantly.

Punjab’s groundwater problem has its origins in India’s Green Revolution, which was launched in the 1970s as a wide-scale bid to bring home-grown food security to the world’s second most populous country.  Government subsidies, mechanisation and technology were introduced to encourage Punjabis to turn their lands over to commercial farming.  As a result, 97% of Punjab is irrigated, and the state is described as the breadbasket of India.

These days rice is the crop of choice – but rice is the cause of the problem.  Farming rice paddy fields requires a lot of water – more than three times the amount of water that Punjab usuallly gets in rainfall each year.  And while surface water from canals fills in part of the shortfall, it’s not enough, so groundwater is needed.  In addition, farmers receive free electricity from the state to run their submersible motors.

The government has done little to regulate groundwater use as it’s political: as farmers and their families make up around 60 percent of Punjab’s population, they represent valuable votes.  At the same time, many Punjabi politicians and officials come from the farmer class. It all adds up to enormous political clout. At the same time, farmers are also tacitly encouraged to grow wheat and rice, as the government buys whatever excess stocks they cannot sell at market.

http://www.nasa.gov/images/content/378067main_water_table%20illus_226.jpg

The averaging function (spatial weighting) used to estimate terrestrial water storage changes from GRACE data is mapped. Warmer colors indicate greater sensitivity to terrestrial water storage changes. Credit: NASA/Matt Rodell

Warmer colors indicate greater sensitivity to terrestrial water storage changes.

Warmer colors indicate greater sensitivity to terrestrial water storage changes.

Beneath northern India’s irrigated fields of wheat, rice, and barley … beneath its densely populated cities of Jaiphur and New Delhi, the groundwater has been disappearing. Halfway around the world, hydrologists, including Matt Rodell of NASA, have been hunting for it.

Where is northern India’s underground water supply going? According to Rodell and colleagues, it is being pumped and consumed by human activities — principally to irrigate cropland — faster than the aquifers can be replenished by natural processes. They based their conclusions — published in the August 20 issue of Nature — on observations from NASA’s Gravity Recovery and Climate Experiment (GRACE).

“If measures are not taken to ensure sustainable groundwater usage, consequences for the 114 million residents of the region may include a collapse of agricultural output and severe shortages of potable water,” said Rodell, who is based at NASA’s Goddard Space Flight Center in Greenbelt, Md.

Groundwater comes from the natural percolation of precipitation and other surface waters down through Earth’s soil and rock, accumulating in aquifers — cavities and layers of porous rock, gravel, sand, or clay. In some of these subterranean reservoirs, the water may be thousands to millions of years old; in others, water levels decline and rise again naturally each year.
India has more malnourished people than any other country.

Around 30% of children under five are underweight, according to the Rapid Survey on Children (RSOC), which was carried out in 2013 and 2014 by the UN and the Indian government. That is a welcome improvement from an estimated 43% a decade ago. But it still leaves children worse-fed in India than Africa and much less healthy than in China, where only 3% of them are underweight.

Favouring curry

Malnutrition leaves Indians weaker and more vulnerable to disease, but that is not the worst of it. When children are underfed it is not only their bodies that are stunted; it is also their minds. The country will never fulfil its gigantic potential if the brains of its young people never develop properly for lack of nutrients. Fighting hunger harder should therefore be a national priority. Unfortunately, progress is slower than it should be, thanks to taboos, corruption and political pride.

Consider India’s school-lunch scheme. Since the late 1990s pupils at public schools have been entitled to a free midday meal. The program has reduced malnutrition and boosted attendance. Yet it could work much better if it were honestly and competently administered. The food served is sometimes rotten, and studies in some states find that a quarter of the subsidies are stolen. Now religious strictures are making things worse. The chief minister of Madhya Pradesh, a state with lots of poor and ill-fed children, recently banned eggs in school lunches because many people consider them non-vegetarian.

By and large social and health indicators across India follow predictable patterns. In states with higher incomes, those nearer the coast and farther south, most health indicators are better. Typical high achievers are Kerala and Tamil Nadu. In landlocked states, poorer ones and in the north, social and health results are usually worse. Notorious backward states include Bihar and Uttar Pradesh. North-eastern states are often outliers, both poor and landlocked but often with high rates of literacy and better health.

Results from the RSOC mostly bear out these trends. Everywhere has seen a reduction in the share of underweight children and in stunting. But it is striking that on occasion higher incomes do not correlate with the biggest health gains. Maharashtra and Gujarat are both states with relatively prosperous people, but Maharashtra’s nutrition levels are better than Gujarat’s. This is also true for rates of immunisation and of open defecation. It appears that Maharashtra’s government has put more emphasis on tackling nutrition problems, for example among its adivasi, or tribal, population.

Two crucial factors are worth looking at. Lower rates of open defecation correlate well with reduced malnutrition. When children live and play in clean environments they are less likely to be infected with parasites that make it hard to absorb nutrients. And states that focus on helping girls and young mothers probably do better at breaking long-term cycles of malnutrition. Where teenage girls have a low body-mass index there seems a greater likelihood mothers will give birth to undernourished children. Proper nutrition for girls and women should be a priority.

Download data for 15 indicators here.

The original RSOC files—for each separate state and India as a whole—are available to download here (note: large file).

Malnutrition in India

Ravenous for reform

India cannot tackle hunger if it suppresses embarrassing data

http://www.economist.com/news/leaders/21656712-india-cannot-tackle-hunger-if-it-suppresses-embarrassing-data-ravenous-reform

SOME of India’s rulers have strong views on food. The home minister, Rajnath Singh, has called for a nationwide ban on slaughtering cows, which as a Hindu he considers holy. At least 20 Indian states and territories (out of 36) ban cow-killing. Since March it has been illegal to possess beef in Maharashtra, and lawmakers in Haryana say those who slaughter cows should be punished as severely as murderers. The education ministry suggests that vegetarian and non-vegetarian students should be segregated in some college canteens; another minister says beef-eaters should move to Pakistan.

Since India is roughly 80% Hindu, it is not surprising that Indian politicians pay respect to Hindu beliefs (many of which they passionately share). But if they care about people as well as sacred animals, they should worry about adding to the national menu, as well as cutting it back.

Political pride is stopping the publication of data that would help India’s states learn from each other. The RSOC survey we cite is big, based on weighing 90,000 children and conducting 210,000 interviews. It was finished eight months ago. Yet apart from a few figures on immunisation rates released in October, the Indian government has failed to make its results public. The UN says the study is sound and blames the government for the delay. The most probable reason for that is because the report casts a shadow over Gujarat, the state once governed by Narendra Modi, the prime minister. The Economist has obtained the full RSOC report and is publishing much of the data this week (see article). Most states show gains, but Gujarat, though prosperous, has worse-than-average rates of child malnutrition. Plausible reasons for that include poor public hygiene and low rates of immunisation.

One reason Indians are less well-nourished than Africans is that more Indians defecate outdoors, so more contract diarrhoea and other diseases that make it harder for children, especially, to absorb the nutrients they consume. The failure to inoculate allows some of these diseases to spread. To deal with these problems, India would have to spend more than a risible 1% of GDP on public health. Alas, Mr Modi as prime minister has overseen cuts in health spending.

Rather than suppress embarrassing information, Mr Modi’s government should publish any data that might help inform better policies. These should focus on girls and women, who are typically worse-fed than their brothers and husbands. Malnourished pregnant mothers give birth to malnourished babies. Even in the wealthiest 20% of Indian households, 26.5% of children are stunted and 17.5% are underweight. It is a fair guess that most of these are female. States, such as Kerala, that try harder to identify the vulnerable and provide them with education and health care achieve better results. Better food policies would make India happier—and cleverer, too

Nutrition in India

Of secrecy and stunting

The government withholds a report on nutrition that contains valuable lessons

http://www.economist.com/news/asia/21656709-government-withholds-report-nutrition-contains-valuable-lessons-secrecy-and

A REMARKABLE story has been unfolding in the past decade in India. A new study—conducted by the government and the UN agency for children, Unicef—offers evidence of a steady and widespread fall in malnutrition. But the picture is still grim. Judged by measures such as the prevalence of “stunting” (when children are unusually short for their age) and “wasting” (when they weigh too little for their height), India is still vastly hungrier than Africa.

India’s government has been sitting on the report for months, though it has been ready since at least October. One rumour suggests official concern about the quality of the data, but Unicef has voiced no such worry. Another possible reason is the pride of India’s prime minister, Narendra Modi, who ruled Gujarat for a dozen years. The new data indicate his relatively prosperous state performed worse than many poorer ones. The Economist has obtained the report, known as the Rapid Survey on Children (RSOC). It shows gains at both national and state levels.

Much of what hitherto was known about nutrition in India came from the National Family Health Survey (NFHS) conducted by the government in 2005 and 2006. Work on a follow-up is under way. Unicef and the government agreed in the meantime to conduct the RSOC. It involved 210,000 interviews across 29 states and territories in 2013 and 2014; more than 90,000 children were measured and weighed, as well as 28,000 teenage girls.

Unicef’s nutrition adviser for South Asia, Victor Aguayo, says India’s overall gains have been “unprecedented”. A decade ago 42.5% of all children under five were underweight. Now the reported rate is just below 30%. That improvement coincided with a period of rapid economic growth, rising household incomes and more spending on welfare such as free cooked midday-meals in schools. Madhya Pradesh in central India cut the proportion of its children who go hungry from 60% to 36%; Bihar in the north, from 56% to 37%.

The case of Maharashtra, a wealthy state on the western coast, is revealing. The proportion of children there who are underweight fell from 37% to 25%. Mr Aguayo cites Maharashtra as a “good example” of how to deal with malnutrition, identifying four crucial changes there: better and more frequent feeding of infants, more care for pregnant women, higher household incomes and a rise in the age at which women begin having babies. Officials and politicians in Maharashtra played a crucial role by helping to target worst-afflicted groups such as tribal people known as adivasis.

Other national trends follow similar patterns. The RSOC suggests that the proportion of children who are wasted fell from nearly 20% to 15%, and the stunting rate fell from 48% to nearly 39%. Yet still, more than half of children in Uttar Pradesh, a massive northern state, are below normal height. And amazingly, even among the wealthiest fifth of Indian households, more than a quarter of children are stunted. This may be because of sexism: mothers and girls get less food, health care and education than males. Over half of all girls aged 15-18 had a low body-mass index, meaning they were likelier to produce undernourished babies.

The RSOC highlights several failures. A deworming campaign has achieved little: not even 28% of under-fives had been given a recent dose. And though many women gave birth in institutions, fewer than half of babies were, as the WHO recommends, breastfed within an hour of birth.

India’s age-old habit of defecating in the open—which distinguishes it from many other developing countries—makes matters worse. The proportion of Indians who do this has fallen from 55% a decade ago to 45%, but that is more than enough to help spread diseases, worms and other parasites that make it more difficult to absorb nutrients even when food is abundant. Poor public hygiene may account for much of India’s failure to make faster improvements in nutrition. There is a clear correlation between open defecation and hunger (see chart).

defecation outdoors

defecation outdoors

http://cdn.static-economist.com/sites/default/files/imagecache/original-size/images/print-edition/20150704_ASC786_1.png

Coincidentally or otherwise, states run in the past decade by Mr Modi’s Bharatiya Janata Party (BJP) appear to be laggards compared with several states that are (or were) under the control of rivals. The most sensitive example is Gujarat, which Mr Modi has touted as a model because incomes there are high. The RSOC shows that the proportion of hungry children in the state fell from 44.6% to 33.5%, but that remains worse than the national average. Maharashtra next door has similar incomes and has fared much better. Gujarat is also worse than average for stunting (42%), severe stunting (18.5%) and wasting (18.7%). Nearly two-fifths of its population defecate out of doors.

Malnutrition

The hungry and forgotten

Growth has helped millions to avoid malnutrition but it still threatens to hold back a generation of rural Chinese

Jun 14th 2014 | SONGJIA VILLAGE, HUNAN PROVINCE

pre-school centre in Songjia

pre-school centre in Songjia

 

http://cdn.static-economist.com/sites/default/files/imagecache/full-width/images/print-edition/20140614_CNP001_0.jpg

http://www.economist.com/news/china/21604220-growth-has-helped-millions-avoid-malnutrition-it-still-threatens-hold-back-generation

THE propaganda message, scrawled in white paint on the side of a wood-frame house, could hardly be more blunt: “Cure stupidity, cure poverty”. The cure for both, in one of China’s poorest counties, seems to be a daily nutritional supplement for children. At a pre-school centre in Songjia, as in more than 600 other poor villages across China, children aged three to six gather to get the stuff with their lunch. If China is to narrow its urban-rural divide, thousands more villages will need to do this much, or more. Widespread malnutrition still threatens to hold back a generation of rural Chinese.

China used to have more undernourished people than anywhere in the world except India: about 300m, or 30% of the population in 1980. Economic growth has pulled half of them out of poverty and hunger. But that still leaves about 150m, mainly in the countryside. Out of 88m children aged six to 15 in the poorest rural areas, around a third suffer from anaemia because of a lack of iron, according to survey data. Iron deficiency can stunt brain development, meaning many of these children will grow up ill-equipped to better their lot. “They are far behind compared with urban kids,” says Lu Mai, secretary-general of China Development Research Foundation (CDRF), a government-run charity. Mr Lu and other experts have been prodding the government to do more. The state subsidises school lunches for 23m children in the 680 poorest counties, as well as nutritional supplements for hundreds of thousands of babies. It is not enough.

Syrian refugee crisis strains Jordan’s water supply

Shortages continue to make regional conflicts worse and force many states to stop growing their own food, NGO says.

http://www.aljazeera.com/news/2015/08/syrian-refugee-crisis-strains-jordan-water-supply-150827011123701.html

The Middle East is facing a water crisis, according to a new report by the World Resources Institute.

The Washington DC-based non-governmental organisation says that, by 2040, the region will experience eight of the 10 worst droughts in the world. Saudi Arabia, Qatar, and Israel will be among the worst affected.

Many countries will have to stop growing their own food. Saudi Arabia, for example, will entirely depend on grain imports by 2016, the report says.

And the lack of water will continue to make conflicts worse in Syria, Palestine, Iraq and elsewhere.

Al Jazeera’s Nisreen El Shamayleh reports from Jordan where, due to the influx of refugees from Syria, the situation is already critical

Is a Lack of Water to Blame for the Conflict in Syria?

A 2006 drought pushed Syrian farmers to migrate to urban centers, setting the stage for massive uprisings

By Joshua Hammer

SMITHSONIAN MAGAZINE

http://www.smithsonianmag.com/innovation/is-a-lack-of-water-to-blame-for-the-conflict-in-syria-72513729

 

An Iraqi girl stands on former marshland, drained in the 1990s because of politically motivated water policies. (Essam Al-Sudani / AFP / Getty Images)
http://thumbs.media.smithsonianmag.com//filer/Scare-Tactics-Iraqi-girl-631.jpg__800x600_q85_crop.jpg

The world’s earliest documented water war happened 4,500 years ago, when the armies of Lagash and Umma, city-states near the junction of the Tigris and Euphrates rivers, battled with spears and chariots after Umma’s king drained an irrigation canal leading from the Tigris. “Enannatum, ruler of Lagash, went into battle,” reads an account carved into an ancient stone cylinder, and “left behind 60 soldiers [dead] on the bank of the canal.”

RELATED CONTENT

Water loss documented by the Gravity Recovery and Climate Experiment (GRACE), a pair of satellites operated by NASA and Germany’s aerospace center, suggests water-related conflict could be brewing on the riverbank again. GRACE measured groundwater usage between 2003 and 2009 and found that the Tigris-Euphrates Basin—comprising Turkey, Syria, Iraq and western Iran—is losing water faster than any other place in the world except northern India . During those six years, 117 million acre-feet of stored freshwater vanished from the region as a result of dwindling rainfall and poor water management policies. That’s equal to all the water in the Dead Sea. GRACE’s director, Jay Famiglietti, a hydrologist at the University of California, Irvine, calls the data “alarming.”

While the scientists captured dropping water levels, political experts have observed rising tensions. In Iraq, the absence of a strong government since 2003, drought and shrinking aquifers have led to a recent spate of assassinations of irrigation department officials and clashes between rural clans. Some experts say that these local feuds could escalate into full-scale armed conflicts .

In Syria, a devastating drought beginning in 2006 forced many farmers to abandon their fields and migrate to urban centers. There’s some evidence that the migration fueled the civil war there, in which 80,000 people have died. “You had a lot of angry, unemployed men helping to trigger a revolution,” says Aaron Wolf, a water management expert at Oregon State University, who frequently visits the Middle East.

Tensions between nations are also high. Since 1975, Turkey’s dam and hydro­power construction has cut water flow to Iraq by 80 percent and to Syria by 40 percent. Syria and Iraq have accused Turkey of hoarding water.

Hydrologists say that the countries need to find alternatives to sucking the aquifers dry—perhaps recycling wastewater or introducing desalination—and develop equitable ways of sharing their rivers. “Water doesn’t know political boundaries. People have to get together and work,” Famiglietti says. One example lies nearby, in an area not known for cross-border cooperation. Israeli and Jordanian officials met last year for the first time in two decades to discuss rehabilitating the nearly dry Jordan River, and Israel has agreed to release freshwater down the river.

“It could be a model” for the Tigris-Euphrates region, says Gidon Bromberg, a co-director of Friends of the Earth Middle East, who helped get the countries together. Wolf, too, remains optimistic, noting that stress can encourage compromise.

History might suggest a way: The world’s first international water treaty, a cuneiform tablet now hanging in the Louvre, ended the war between Lagash and Umma.

 

 

iraq_water-bassin

iraq_water-bassin

iraq_regions_water

iraq_regions_water

SYRIA_WATER_CHLORINE_SUPPLY

SYRIA_WATER_CHLORINE_SUPPLY

 

Water supply key to outcome of conflicts in Iraq and Syria, experts warn

Security analysts in London and Baghdad say control of rivers and dams has become a major tactical weapon for Isis

http://www.theguardian.com/environment/2014/jul/02/water-key-conflict-iraq-syria-isis

The outcome of the Iraq and Syrian conflicts may rest on who controls the region’s dwindling water supplies, say security analysts in London and Baghdad.

Rivers, canals, dams, sewage and desalination plants are now all military targets in the semi-arid region that regularly experiences extreme water shortages, says Michael Stephen, deputy director of the Royal United Services Institute think tank in Qatar, speaking from Baghdad.

“Control of water supplies gives strategic control over both cities and countryside. We are seeing a battle for control of water. Water is now the major strategic objective of all groups in Iraq. It’s life or death. If you control water in Iraq you have a grip on Baghdad, and you can cause major problems. Water is essential in this conflict,” he said.

Isis Islamic rebels now control most of the key upper reaches of the Tigris and Euphrates, the two great rivers that flow from Turkey in the north to the Gulf in the south and on which all Iraq and much of Syria depends for food, water and industry.

 

http://static.guim.co.uk/ni/1404220722088/Iraq_water_dams.svg

“Rebel forces are targeting water installations to cut off supplies to the largely Shia south of Iraq,” says Matthew Machowski, a Middle East security researcher at the UK houses of parliament and Queen Mary University of London.

“It is already being used as an instrument of war by all sides. One could claim that controlling water resources in Iraq is even more important than controlling the oil refineries, especially in summer. Control of the water supply is fundamentally important. Cut it off and you create great sanitation and health crises,” he said

Isis now controls the Samarra barrage west of Baghdad on the River Tigris and areas around the giant Mosul Dam, higher up on the same river. Because much of Kurdistan depends on the dam, it is strongly defended by Kurdish peshmerga forces and is unlikely to fall without a fierce fight, says Machowski.

Last week Iraqi troops were rushed to defend the massive 8km-long Haditha Dam and its hydroelectrical works on the Euphrates to stop it falling into the hands of Isis forces. Were the dam to fall, say analysts, Isis would control much of Iraq’s electricity and the rebels might fatally tighten their grip on Baghdad.

Securing the Haditha Dam was one of the first objectives of the American special forces invading Iraq in 2003. The fear was that Saddam Hussein’s forces could turn the structure that supplies 30% of all Iraq’s electricity into a weapon of mass destruction by opening the lock gates that control the flow of the river. Billions of gallons of water could have been released, power to Baghdad would have been cut off, towns and villages over hundreds of square miles flooded and the country would have been paralysed.

https://i.guim.co.uk/img/static/sys-images/Guardian/Pix/pictures/2014/7/2/1404300383396/

Iraqi men move a boat that was stuck on the banks of the Euphrates River after supplies were blocked by anti-government fighters who control a dam further upstream.

In April, Isis fighters in Fallujah captured the smaller Nuaimiyah Dam on the Euphrates and deliberately diverted its water to “drown” government forces in the surrounding area. Millions of people in the cities of Karbala, Najaf, Babylon and Nasiriyah had their water cut off but the town of Abu Ghraib was catastrophically flooded along with farms and villages over 200 square miles. According to the UN, around 12,000 families lost their homes.

Earlier this year Kurdish forces reportedly diverted water supplies from the Mosul Dam. Equally, Turkey has been accused of reducing flows to the giant Lake Assad, Syria’s largest body of fresh water, to cut off supplies to Aleppo, and Isis forces have reportedly targeted water supplies in the refugee camps set up for internally displaced people.

Iraqis fled from Mosul after Isis cut off power and water and only returned when they were restored, says Machowski. “When they restored water supplies to Mosul, the Sunnis saw it as liberation. Control of water resources in the Mosul area is one reason why people returned,” said Machowski.

Increasing temperatures, one of the longest and most severe droughts in 50 years and the steady drying up of farmland as rainfall diminishes have been identified as factors in the political destabilisation of Syria.

Both Isis forces and President Assad’s army are said to have used water tactics to control the city of Aleppo. The Tishrin Dam on the Euphrates, 60 miles east of the city, was captured by Isis in November 2012.

The use of water as a tactical weapon has been used widely by both Isis and the Syrian government, says Nouar Shamout, a researcher with Chatham House. “Syria’s essential services are on the brink of collapse under the burden of continuous assault on critical water infrastructure. The stranglehold of Isis, neglect by the regime, and an eighth summer of drought may combine to create a water and food crisis which would escalate fatalities and migration rates in the country’s ongoing three-year conflict,” he said.

“The deliberate targeting of water supply networks … is now a daily occurrence in the conflict. The water pumping station in Al-Khafsah, Aleppo, stopped working on 10 May, cutting off water supply to half of the city. It is unclear who was responsible; both the regime and opposition forces blame each other, but unsurprisingly in a city home to almost three million people the incident caused panic and chaos. Some people even resorted to drinking from puddles in the streets,” he said .

Water will now be the key to who controls Iraq in future, said former US intelligence officer Jennifer Dyer on US television last week. “If Isis has any hope of establishing itself on territory, it has to control some water. In arid Iraq, water and lines of strategic approach are the same thing”.

 

https://i.guim.co.uk/img/static/sys-images/Guardian/Pix/pictures/2014/7/2/1404300629581/

A satellite view showing the two main rivers running from Turkey through Syria and Iraq. Credits: MODIS/NASA

The Euphrates River, the Middle East’s second longest river, and the Tigris, have historically been at the centre of conflict. In the 1980s, Saddam Hussein drained 90% of the vast Mesopotamian marshes that were fed by the two rivers to punish the Shias who rose up against his regime. Since 1975, Turkey’s dam and hydropower constructions on the two rivers have cut water flow to Iraq by 80% and to Syria by 40%. Both Syria and Iraq have accused Turkey of hoarding water and threatening their water supply.

“There has never been an outright war over water but water has played extremely important role in many Middle East conflicts. Control of water supply is crucial”, said Stephen.

It could also be an insurmountable problem should the country split into three, he said. “Water is one of the most dangerous problems in Iraq. If the country was split there would definitely be a war over water. Nobody wants to talk about that,” he said.

Some academics have suggested that Tigris and Euphrates will not reach the sea by 2040 if rainfall continues to decrease at its present rate.

 

SYRIA: Why the water shortages?

http://www.irinnews.org/report/88554/syria-why-the-water-shortages

rivers running from Turkey through Syria and Iraq

rivers running from Turkey through Syria and Iraq

http://www.irinnews.org/photo/

The Barada River, shown here in Damascus, is the only notable river flowing entirely within Syrian territory. The city’s water supplies are under huge strain

DAMASCUS, 25 March 2010 (IRIN) – Poor planning and management, wasteful irrigation systems, intensive wheat and cotton farming and a rapidly growing population are straining water resources in Syria in a year which has seen unprecedented internal displacement as a result of drought in eastern and northeastern parts of the country.

“Population [estimated at 24 million in 2009] growth, urbanization and increased economic activity have contributed to the water crisis, as have climate change and mismanagement of the water sector,” said a local expert, who preferred anonymity.

Compared to other Middle Eastern countries, Syria is not naturally water poor. According to the UN Development Programme (UNDP) Arab Human Development Report 2009, Syria was ranked 13th out of 20 Arab countries for precipitation per capita.

Annual per capita water consumption was 300 cubic metres, making it ninth out of 18 Arab countries but significantly below the global water scarcity mark of 1,000 cubic metres per capita. The global average is 6,750 cubic metres.

“Syria is relatively rich in terms of natural water resources, but there has been a huge deterioration in availability per capita,” said Francesca de Châtel, a Damascus-based water expert and author of Water Sheikhs and Dam Builders: Stories of Water and People in the Middle East.

In 2007 Syria consumed 19.2 billion cubic metres of water – 3.5 billion more than the amount of water replenished naturally, with the deficit coming from groundwater and reservoirs, according to the Ministry of Irrigation.

Wasteful agriculture 

Agriculture accounts for almost 90 percent of the country’s water consumption, according to government and private sector.

Agricultural policies encourage water-hungry wheat and cotton cultivation, and inefficient irrigation methods mean much water is wasted.

“Irrigation by flooding uses 30-40 percent more water than modern drip irrigation,” said de Châtel.

Something that bodes ill for the future is that despite a 2005 law against drilling wells, illegal wells have proliferated and are being drilled ever deeper to reach shrinking groundwater reserves. “Farmers have depleted groundwater by extracting water for their crops,” said de Châtel.

City limits

The recent influx of hundreds of thousands of people from drought-affected regions into towns and cities is placing a huge strain on urban water supplies.

The Damascus water basin is a closed water system and its resources are being depleted. The city water network leaks up to 60 percent of the water it carries, according to the local authorities. Migrants living on the outskirts are having to pay for water from tankers at an inflated price.

“The root issue is the lack of strategy or proper management,” said the above-mentioned local water expert. “The Damascus basin could have been helped by creating industrial areas in the relatively water-rich coastal zones rather than encouraging businesses to Damascus, for example. But there is no forward thinking and now the urban population will suffer.”

“There urgently needs to be a stronger legal framework and enforcement of the laws,” said de Châtel.

 

Palestinian malnutrition at African levels under Israeli curbs, say MPs
http://www.ifamericansknew.org/stat/malnutrition.html

By Ben Russell
Political Correspondent From the UK Independent
February 5, 2004

Malnutrition rates in the Gaza Strip and parts of the West Bank are as bad as those in sub-Saharan Africa, MPs said yesterday. They warned that the Israeli security fence around the occupied territories was “destroying the Palestinian economy and creating widespread poverty”.

The all-party Commons International Development Committee called for European Union trade sanctions to be imposed on Israel until it allowed the free export of goods from the West Bank and Gaza.

The committee’s report also condemned suicide bombings as “morally abhorrent” and “a catastrophic tactic that has done great harm to the Palestinian cause”.

MPs called on the Palestinian Authority to be more vocal in its condemnation of attacks. “Israel’s security measures are preventing Palestinians from accessing services as well as inhibiting humanitarian and development work,” the MPs said. “They are destroying the Palestinian economy and creating widespread poverty.”

The MPs, who carried out a fact-finding trip to Israel as part of their six-month inquiry, criticised corruption and mismanagement by the Palestinian Authority, but also condemned the actions of the Israeli government.

They said they understood why the Israeli government had decided to build its 425-mile security fence, but added that it had displaced Palestinian homes, destroyed farms and severely disrupted trade.

Tony Baldry, the Conservative chairman of the committee, said: “Our report is a balanced assessment of the humanitarian situation in the occupied Palestinian territories. It shows that Israel’s security policy is having a marked impact on everyday life.

“Key measures, such as the construction of a security barrier, may bring the mirage of immediate security to Israelis, but the level of despair felt by ordinary Palestinians at being denied an ordinary life can only increase the supply of suicide bombers. Nor is it likely to elicit any concessions from the Palestinian leaders.”

MPs said that the Israeli government and many ordinary Israelis regarded all Palestinians as potential suicide bombers, but said that “it is tragically the case that for a number of Palestinians, the harder the Israeli Defence Force bears down on them the more they feel obliged to resist by force of arms”.

The MPs said that the barrier “destroyed the viability of a Palestinian state” and risked having an irreversible effect on the Palestinian people.

They said: “Rates of malnutrition in Gaza and parts of the West Bank are as bad as anything one would find in sub-Saharan Africa. The Palestinian economy has all but collapsed. Unemployment rates are in the region of 60 to 70 per cent. “The EU should not shy away from using economic pressure to gain political leverage with Israel.”

The report said that Palestinian farmers had land confiscated, crops damaged and were “plagued” by problems in getting goods to market.

MPs condemned the Israeli government for preventing the free export of goods from the West Bank and Gaza, and urged the EU to suspend Israel’s preferential tariff rates until they allow Palestinians free access to European markets. They said: “It is hard to avoid the conclusion that there is a deliberate Israeli strategy of putting the lives of ordinary Palestinians under stress as part of a strategy to bring the population under heel.

The report said movement restrictions on the Palestinians were justified by Israel as security measures, but warned that “in reality they have been a mechanism to put pressure on the Palestinians by crippling the economy”.

 

State Comptroller’s poverty report reveals bleak image of rampant hunger among Israel’s poor

Goel Beno  04.08.14 / Israel News

http://www.ynetnews.com/articles/0,7340,L-4508210,00.html

The State Comptroller’s poverty report revealed that 894,000 Israelis, of them 306,000 children, go for as long as an entire day without food, or are forced cut down the size of their meals because they can’t afford basic food products.

The grim report was released Monday and placed the blame on one main culprit – the Israeli government.

“A society that caters to the poorest and neediest not only improves its sense of dignity and rights – but also its image,” said Comptroller Yosef Shapira.

 

Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System

Lisa A. Barker,1,* Belinda S. Gout,1 and Timothy C. Crowe2

Author information ► Article notes ► Copyright and License information ►

Int J Environ Res Public Health. 2011 Feb; 8(2): 514–527.

Published online 2011 Feb 16. doi:  10.3390/ijerph8020514

This article has been cited by other articles in PMC.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084475/

 

Recently, the definition of malnutrition has been clarified by the European Society of Parenteral and Enteral Nutrition (ESPEN) to highlight the differences between cachexia, sarcopenia (loss of muscle mass and function) and malnutrition [18]. Cachexia can be defined as a “multifactorial syndrome characterized by severe body weight, fat and muscle loss and increased protein catabolism due to underlying disease(s)” [18]. Therefore, malnutrition seen in hospitalised patients is often a combination of cachexia (disease-related) and malnutrition (inadequate consumption of nutrients) as opposed to malnutrition alone. Within the context of this review, the definition of malnutrition adopted refers to the complex interplay between underlying disease, disease-related metabolic alterations and the reduced availability of nutrients (because of reduced intake, impaired absorption and/or increased losses or a combination of these) which is a combination of cachexia and malnutrition [18].

In 1859, Florence Nightingale wrote about hospitalised soldiers during the Crimea war, starving amongst plenty of food [19]. Over 100 years later, beginning from the 1970s, numerous authors have reported malnutrition rates in hospital patients to be approximately 35%, with 30 to 55% of patients entering acute hospitals being at risk of malnutrition [2024]. Studies have also reported on factors which contribute to malnutrition (see Table 1), consequences of malnutrition and the benefit nutrition support can offer malnourished patients [15,2527].

Table 1.

Factors contributing to malnutrition in acute care patients (reproduced with permission from [15]; published by Elsevier, 2007).

Over the last 30 years, advances in medical, surgical, nursing and nutrition support have been made; however, numerous publications continue to report the high prevalence and lack of awareness of malnutrition [11,17,28]. To improve detection rate, many studies have investigated various methods for screening and assessing malnutrition, and shown many of these tools to be simple, fast, accurate and of utility in the clinical setting [2933]. Despite the availability of such tools, malnutrition prevalence remains high and appropriate treatment is not always being delivered. This review aims to briefly summarise nutrition screening and assessment tools available for use in hospitalised patients and provides a short discussion on malnutrition prevalence, consequences and treatment to provide clinicians with a starting point for achieving successful malnutrition identification.

 

 

 

 

Advertisements

Read Full Post »


Voluntary and Involuntary S- Insufficiency

Writer and Curator: Larry H Bernstein, MD, FCAP 

Transthyretin and the Stressful Condition

Introduction

This article is written among a series of articles concerned with stress, obesity, diet and exercise, as well as altitude and deep water diving for extended periods, and their effects.  There is a reason that I focus on transthyretin (TTR), although much can be said about micronutients and vitamins, and fat soluble vitamins in particular, and iron intake during pregnancy.    While the importance of vitamins and iron are well accepted, the metabolic basis for their activities is not fully understood.  In the case of a single amino acid, methionine, it is hugely important because of the role it plays in sulfur metabolism, the sulfhydryl group being essential for coenzyme A, cytochrome c, and for disulfide bonds.  The distribution of sulfur, like the distribution of iodine, is not uniform across geographic regions.  In addition, the content of sulfur found in plant sources is not comparable to that in animal protein.  There have been previous articles at this site on TTR, amyloid and sepsis.

Transthyretin and Lean Body Mass in Stable and Stressed State

https://pharmaceuticalintelligence.com/2013/12/01/transthyretin-and-lean-body-mass-in-stable-and-stressed-state/

A Second Look at the Transthyretin Nutrition Inflammatory Conundrum

https://pharmaceuticalintelligence.com/2012/12/03/a-second-look-at-the-transthyretin-nutrition-inflammatory-conundrum/

Stabilizers that prevent transthyretin-mediated cardiomyocyte amyloidotic toxicity

https://pharmaceuticalintelligence.com/2013/12/02/stabilizers-that-prevent-transthyretin-mediated-cardiomyocyte-amyloidotic-toxicity/

Thyroid Function and Disorders

https://pharmaceuticalintelligence.com/2015/02/05/thyroid-function-and-disorders/

Proteomics, Metabolomics, Signaling Pathways, and Cell Regulation: a Compilation of Articles in the Journal http://pharmaceuticalintelligence.com

https://pharmaceuticalintelligence.com/2014/09/01/compilation-of-references-in-leaders-in-pharmaceutical-intelligence-about-proteomics-metabolomics-signaling-pathways-and-cell-regulation-2/

Malnutrition in India, high newborn death rate and stunting of children age under five years

https://pharmaceuticalintelligence.com/2014/07/15/malnutrition-in-india-high-newborn-death-rate-and-stunting-of-children-age-under-five-years/

Vegan Diet is Sulfur Deficient and Heart Unhealthy

https://pharmaceuticalintelligence.com/2013/11/17/vegan-diet-is-sulfur-deficient-and-heart-unhealthy/

How Methionine Imbalance with Sulfur-Insufficiency Leads to Hyperhomocysteinemia

https://pharmaceuticalintelligence.com/2013/04/04/sulfur-deficiency-leads_to_hyperhomocysteinemia/

Amyloidosis with Cardiomyopathy

https://pharmaceuticalintelligence.com/2013/03/31/amyloidosis-with-cardiomyopathy/

Advances in Separations Technology for the “OMICs” and Clarification of Therapeutic Targets

https://pharmaceuticalintelligence.com/2012/10/22/advances-in-separations-technology-for-the-omics-and-clarification-of-therapeutic-targets/

Sepsis, Multi-organ Dysfunction Syndrome, and Septic Shock: A Conundrum of Signaling Pathways Cascading Out of Control

https://pharmaceuticalintelligence.com/2012/10/13/sepsis-multi-organ-dysfunction-syndrome-and-septic-shock-a-conundrum-of-signaling-pathways-cascading-out-of-control/

Automated Inferential Diagnosis of SIRS, sepsis, septic shock

https://pharmaceuticalintelligence.com/2012/08/01/automated-inferential-diagnosis-of-sirs-sepsis-septic-shock/

Transthyretin and the Systemic Inflammatory Response 

Transthyretin has been widely used as a biomarker for identifying protein-energy malnutrition (PEM) and for monitoring the improvement of nutritional status after implementing a nutritional intervention by enteral feeding or by parenteral infusion. This has occurred because transthyretin (TTR) has a rapid removal from the circulation in 48 hours and it is readily measured by immunometric assay. Nevertheless, concerns have been raised about the use of TTR in the ICU setting, which prompts a review of the actual benefit of using this test in a number of settings. TTR is easily followed in the underweight and the high risk populations in an ambulatory setting, which has a significant background risk of chronic diseases.  It is sensitive to the systemic inflammatory response syndrom (SIRS), and needs to be understood in the context of acute illness to be used effectively. There are a number of physiologic changes associated with SIRS and the injury/repair process that will affect TTR and will be put in context in this review. The most important point is that in the context of an ICU setting, the contribution of TTR is significant in a complex milieu.  copyright @ Bentham Publishers Ltd. 2009.

Transthyretin as a marker to predict outcome in critically ill patients.
Arun Devakonda, Liziamma George, Suhail Raoof, Adebayo Esan, Anthony Saleh, Larry H. Bernstein.
Clin Biochem Oct 2008; 41(14-15): 1126-1130

A determination of TTR level is an objective method od measuring protein catabolic loss of severly ill patients and numerous studies show that TTR levels correlate with patient outcomes of non-critically ill patients. We evaluated whether TTR level correlates with the prevalence of PEM in the ICUand evaluated serum TTR level as an indicator of the effectiveness of nutrition support and the prognosis in critically ill patients.

TTR showed excellent concordance with patients classified with PEM or at high malnutrition risk, and followed for 7 days, it is a measure of the metabolic burden. TTR levels did not respond early to nutrition support because of the delayed return to anabolic status. It is particularly helpful in removing interpretation bias, and it is an excellent measure of the systemic inflammatory response concurrent with a preexisting state of chronic inanition.

 The Stressful Condition as a Nutritionally Dependent Adaptive Dichotomy

Yves Ingenbleek and Larry Bernstein
Nutrition 1999;15(4):305-320 PII S0899-9007(99)00009-X

The injured body manifests a cascade of cytokine-induced metabolic events aimed at developing defense mechanisms and tissue repair. Rising concentrations of counterregulatory hormones work in concert with cytokines to generate overall insulin and insulin-like growth factor 1 (IGF-1), postreceptor resistance and energy requirements grounded on lipid dependency. Dalient features are self-sustained hypercortisolemia persisting as long as cytokines are oversecreted and down-regulation of the hypothalamo-pituitary-thyroid axis stabilized at low basal levels. Inhibition of thyroxine 5’deiodinating activity (5’DA) accounts for the depressed T3 values associated with the sparing of both N and energy-consuming processes. Both the liver and damaged territories adapt to stressful signals along up-regulated pathways disconnected from the central and peripheral control systems. Cytokines stimulate 5’DA and suppress the synthesis of TTR, causing the drop of retinol-binding protein (RBP) and the leakage of increased amounts of T4 and retinol in free form. TTR and RBP thus work as prohormonal reservoirs of precursor molecules which need to be converted into bioactive derivatives (T3 and retinoic acids) to reach transcriptional efficiency. The converting steps (5’DA and cellular retinol-binding protein-1) are activated to T4 and retinol, themselves operating as limiting factors to positive feedback loops. …The suicidal behavior of TBG, CBG, and IGFBP-3 allows the occurrence of peak endocrine and mitogenic influences at the site of inflammation. The production rate of TTR by the liver is the main determinant of both the hepatic release and blood transport of holoRBP, which explains why poor nutritional status concomitantly impairs thyroid- and retinoid-dependent acute phase responses, hindering the stressed body to appropriately face the survival crisis.  …
abbreviations: TBG, thyroxine-binding globulain; CBG, cortisol-binding globulin; IGFBP-3, insulin growth factor binding protein-3; TTR, transthyretin; RBP, retionol-binding protein.

Why Should Plasma Transthyretin Become a Routine Screening Tool in Elderly Persons? 

Yves Ingenbleek.
J Nutrition, Health & Aging 2009.

The homotetrameric TTR molecule (55 kDa as MM) was first identified in cerebrospinal fluid (CSF).  The initial name of prealbumin (PA)  was assigned based on the electrophoretic migration anodal to albumin. PA was soon recognized as a specific binding protein for thyroid hormone. and also of plasma retinol through the mediation of the small retinol-binding protein (RBP, 21 kDa as MM), which has a circulating half-life half that of TTR (24 h vs 48 h).

There exist at least 3 goos reasons why TTR should become a routine medical screening test in elderly persons.  The first id grounded on the assessment of protein nutritional status that is frequently compromized and may become a life threatening condition.  TTR was proposed as a marker of protein-energy malnutrition (PEM) in 1972. As a result of protein and energy deprivation, TTR hepatic synthesis is suppressed whereas all plasma indispensable amino acids (IAAs) manifest declining trends with the sole exception of methionine (Met) whose concentration usually remains unmodified. By comparison with ALB and transferrin (TF) plasma values, TTR did reveal a much higher degree of reactivity to changes in protein status that has been attributed to its shorter biological half-life and to its unusual tryptophan richness. The predictive ability of outcome offered by TTR is independent of that provided by ALB and TF. Uncomplicated PEM primarily affects the size of body nitrogen (N) pools, allowing reduced protein syntheses to levels compatible with survival.  These adaptiver changes are faithfully identified by the serial measurement of TTR whose reliability has never been disputed in protein-depleted states. On the contrary, the nutritional relevance of TTR has been controverted in acute and chronic inflammatory conditions due to the cytokine-induced transcriptional blockade of liver synthesis which is an obligatory step occurring independently from the prevailing nutritional status. Although PEM and stress ful disorders refer to distinct pathogenic mechanisms, their combined inhibitory effects on TTR liber production fueled a long-lasting strife regarding a poor specificity.  Recent body compositional studies have contributed to disentagling these intermingled morbidities, showing that evolutionary patterns displayed by plasma TTR are closely correlated with the fluctuations of lean body mass (LBM).

The second reason follows from advances describing the unexpected relationship established between TTR and homocysteine (Hcy), a S-containing AA not found in customary diets but resulting from the endogenous transmethylation of dietary methionine.  Hcy may be recycled to Met along a remethylation pathway (RM) or irreversibly degraded throughout the transsulfuration (TS) cascade to relase sulfaturia as end-product. Hcy is thus situated at the crossrad of RM and TS pathways which are in equilibrium keeping plasma Met values unaltered.  Three dietary water soluble B viatamins are implicated in the regulation of the Hcy-Met cycle. Folates (vit B9) are the most powerful agent, working as a supplier of the methyl group required for the RM process whereas cobalamines (vit B12) and pyridoxine (vit B6) operate as cofactors of Met-synthase and cystathionine-β-synthase.  Met synthase promotes the RM pathway whereas the rate-limiting CβS governs the TS degradative cascade. Dietary deficiency in any of the 3 vitamins may upregulate Hcy plasma values, an acquied biochemiucal anomaly increasingly encountered in aged populations.

The third reason refers to recent and fascinating data recorded in neurobiology and emphasizing the specific properties of TTR in the prevention of brain deterioration. TTR participates directly in the maintenance of memory and normal cognitive processes during the aging process by acting on the retinoid signaling pathway.  Moreover, TTR may bind amyloid β peptide in vitro, preventing its transformation into toxic amyloid fibrils and amyloid plaques.  TTR works as a limiting factor for the plasma transport of retinoid, which in turn operates as a limiting determinant of both physiologically active retinoic acid (RA) derivatives, implying that any fluctuation in protein status might well entail corresponding  alterations in cellular bioavailability of retinoid compounds.  Under normal aging circumstances, the concentration of retinoid compounds declines in cerebral tissues together with the downregulation of RA receptor expression. In animal models, depletion of RAs causes the deposition of amyloid-β peptides, favoring the formation of amyloid plaques.

Prealbumin and Nutritional Evaluation

Larry Bernstein, Walter Pleban
Nutrition Apr 1996; 12(4):255-259.
http://nutritionjrnl.com/article/S0899-9007(96)90852-7

We compressed 16-test-pattern classes of albumin (ALB), cholesterol (CHOL), and total protein (TPR) in 545 chemistry profiles to 4 classes by conveerting decision values to a number code to separate malnourished (1 or 2) from nonmalnourished (NM)(0) patients using as cutoff values for NM (0), mild (1), and moderate (2): ALB 35, 27 g/L; TPR 63, 53 g/L; CHOL 3.9, 2.8 mmol/L; and BUN 9.3, 3.6 mmol/L. The BUN was found to have  to have too low an S-value to make a contribution to the compressed classification. The cutoff values for classifying the data were assigned prior to statistical analysis, after examining information in the structured data. The data was obtained by a natural experiment in which the test profiles routinely done by the laboratory were randomly extracted. The analysis identifies the values used that best classify the data and are not dependent on distributional assumptions. The data were converted to 0, 1, or 2 as outcomes, to create a ternary truth table (eaxch row in nnn, the n value is 0 to 2). This allows for 3(81) possible patterns, without the inclusion of prealbumin (TTR). The emerging system has much fewer patterns in the information-rich truth table formed (a purposeful, far from random event). We added TTR, coded, and examined the data from 129 patients. The classes are a compressed truth table of n-coded patterns with outcomes of 0, 1, or 2 with protein-energy malnutrition (PEM) increasing from an all-0 to all-2 pattern.  Pattern class (F=154), PAB (F=35), ALB (F=56), and CHOL (F=18) were different across PEM class and predicted PEM class (R-sq. = 0.7864, F=119, p < E-5). Kruskall-Wallis analysis of class by ranks was significant for pattern class E-18), TTR (6.1E-15) ALB (E-16), CHOL (9E-10), and TPR (5E-13). The medians and standard error (SEM) for TTR, ALB, and CHOL of four TTR classes (NM, mild, mod, severe) are: TTR = 209, 8.7; 159, 9.3; 137, 10.4; 72, 11.1 mg/L. ALB – 36, 0.7; 30.5, 0.8; 25.0, 0.8; 24.5, 0.8 g/L. CHOL = 4.43, 0.17; 4.04, 0.20; 3.11, 0.21; 2.54, 0.22 mmol/L. TTR and CHOL values show the effect of nutrition support on TTR and CHOL in PEM. Moderately malnourished patients receiving nutrition support have TTR values in the normal range at 137 mg/L and at 159 mg/L when the ALB is at 25 g/L or at 30.5 g/L.

An Informational Approach to Likelihood of Malnutrition 

Larry Bernstein, Thomas Shaw-Stiffel, Lisa Zarney, Walter Pleban.
Nutrition Nov 1996;12(11):772-776.  PII: S0899-9007(96)00222-5.
http://dx.doi.org:/nutritionjrnl.com/article/S0899-9007(96)00222-5

Unidentified protein-energy malnutrition (PEM) is associated with comorbidities and increased hospital length of stay. We developed a model for identifying severe metabolic stress and likelihood of malnutrition using test patterns of albumin (ALB), cholesterol (CHOL), and total protein (TP) in 545 chemistry profiles…They were compressed to four pattern classes. ALB (F=170), CHOL (F = 21), and TP (F = 5.6) predicted PEM class (R-SQ = 0.806, F= 214; p < E^-6), but pattern class was the best predictor (R-SQ = 0.900, F= 1200, p< E^-10). Ktuskal-Wallis analysis of class by ranks was significant for pattern class (E^18), ALB (E^-18), CHOL (E^-14), TP (@E^-16). The means and SEM for tests in the three PEM classes (mild, mod, severe) were; ALB – 35.7, 0.8; 30.9, 0.5; 24.2, 0.5 g/L. CHOL – 3.93, 0.26; 3.98, 0.16; 3.03, 0.18 µmol/L, and TP – 68.8, 1.7; 60.0, 1.0; 50.6, 1.1 g/L. We classified patients at risk of malnutrition using truth table comprehension.

Downsizing of Lean Body Mass is a Key Determinant of Alzheimer’s Disease

Yves Ingenbleek, Larry Bernstein
J Alzheimer’s Dis 2015; 44: 745-754.
http://dx.doi.org:/10.3233/JAD-141950

Lean body mass (LBM) encompasses all metabolically active organs distributed into visceral and structural tissue compartments and collecting the bulk of N and K stores of the human body. Transthyretin (TTR)  is a plasma protein mainly secreted by the liver within a trimolecular TTR-RBP-retinol complex revealing from birth to old age strikingly similar evolutionary patterns with LBM in health and disease. TTR is also synthesized by the choroid plexus along distinct regulatory pathways. Chronic dietary methionine (Met) deprivation or cytokine-induced inflammatory disorders generates LBM downsizing following differentiated physiopathological processes. Met-restricted regimens downregulate the transsulfuration cascade causing upstream elevation of homocysteine (Hcy) safeguarding Met homeostasis and downstream drop of hydrogen sulfide (H2S) impairing anti-oxidative capacities. Elderly persons constitute a vulnerable population group exposed to increasing Hcy burden and declining H2S protection, notably in plant-eating communities or in the course of inflammatory illnesses. Appropriate correction of defective protein status and eradication of inflammatory processes may restore an appropriate LBM size allowing the hepatic production of the retinol circulating complex to resume, in contrast with the refractory choroidal TTR secretory process. As a result of improved health status, augmented concentrations of plasma-derived TTR and retinol may reach the cerebrospinal fluid and dismantle senile amyloid plaques, contributing to the prevention or the delay of the onset of neurodegenerative events in elderly subjects at risk of Alzheimer’s disease.

Amyloidogenic and non-amyloidogenic transthyretin variants interact differently with human cardiomyocytes: insights into early events of non-fibrillar tissue damage

Pallavi Manral and Natalia Reixach
Biosci.Rep.(2015)/35/art:e00172 http://dx.doi.org:/10.1042/BSR20140155

TTR (transthyretin) amyloidosis are diseases characterized by the aggregation and extracellular deposition of the normally soluble plasma protein TTR. Ex vivo and tissue culture studies suggest that tissue damage precedes TTR fibril deposition, indicating that early events in the amyloidogenic cascade have an impact on disease development. We used a human cardiomyocyte tissue culture model system to define these events. We previously described that the amyloidogenic V122I TTR variant is cytotoxic to human cardiac cells, whereas the naturally occurring, stable and non-amyloidogenic T119M TTR variant is not. We show that most of the V122I TTR interacting with the cells is extracellular and this interaction is mediated by a membraneprotein(s). In contrast, most of the non-amyloidogenic T119M TTR associated with the cells is intracellular where it undergoes lysosomal degradation. The TTR internalization process is highly dependent on membrane cholesterol content. Using a fluorescent labelled V122I TTR variant that has the same aggregation and cytotoxic potential as the native V122I TTR, we determined that its association with human cardiomyocytes is saturable with a KD near 650nM. Only amyloidogenic V122I TTR compete with fluorescent V122I force ll-binding sites. Finally, incubation of the human cardiomyocytes with V122I TTR but not with T119M TTR, generates superoxide species and activates caspase3/7. In summary, our results show that the interaction of the amyloidogenic V122I TTR is distinct from that of a non-amyloidogenic TTR variant and is characterized by its retention at the cell membrane, where it initiates the cytotoxic cascade.

Emerging roles for retinoids in regeneration and differentiation in normal and disease states

Lorraine J. Gudas
Biochimica et Biophysica Acta 1821 (2012) 213–221
http://dx.doi.org:/10.1016/j.bbalip.2011.08.002

The vitamin (retinol) metabolite, all-transretinoic acid (RA), is a signaling molecule that plays key roles in the development of the body plan and induces the differentiation of many types of cells. In this review the physiological and pathophysiological roles of retinoids (retinol and related metabolites) in mature animals are discussed. Both in the developing embryo and in the adult, RA signaling via combinatorial Hoxgene expression is important for cell positional memory. The genes that require RA for the maturation/differentiation of T cells are only beginning to be cataloged, but it is clear that retinoids play a major role in expression of key genes in the immune system. An exciting, recent publication in regeneration research shows that ALDH1a2(RALDH2), which is the rate-limiting enzyme in the production of RA from retinaldehyde, is highly induced shortly after amputation in the regenerating heart, adult fin, and larval fin in zebrafish. Thus, local generation of RA presumably plays a key role in fin formation during both embryogenesis and in fin regeneration. HIV transgenic mice and human patients with HIV-associated kidney disease exhibit a profound reduction in the level of RARβ protein in the glomeruli, and HIV transgenic mice show reduced retinol dehydrogenase levels, concomitant with a greater than 3-fold reduction in endogenous RA levels in the glomeruli. Levels of endogenous retinoids (those synthesized from retinol within cells) are altered in many different diseases in the lung, kidney, and central nervous system, contributing to pathophysiology.

The Membrane Receptor for Plasma Retinol-Binding Protein, A New Type of Cell-Surface Receptor

Hui Sun and Riki Kawaguchi
Intl Review Cell and Molec Biol, 2011; 288:Chap 1. Pp 1:34
http://dx.doi.org:/10.1016/B978-0-12-386041-5.00001-7

Vitamin A is essential for diverse aspects of life ranging from embryogenesis to the proper functioning of most adul torgans. Its derivatives (retinoids) have potent biological activities such as regulating cell growth and differentiation. Plasma retinol-binding protein (RBP) is the specific vitamin A carrier protein in the blood that binds to vitamin A with high affinity and delivers it to target organs. A large amount of evidence has accumulated over the past decades supporting the existence of a cell-surface receptor for RBP that mediates cellular vitamin A uptake. Using an unbiased strategy, this specific cell-surface RBP receptor has been identified as STRA6, a multi-transmembrane domain protein with previously unknown function. STRA6 is not homologous to any protein of known function and represents a new type of cell-surface receptor. Consistent with the diverse functions of vitamin A, STRA6 is widely expressed in embryonic development and in adult organ systems. Mutations in human STRA6 are associated with severe pathological phenotypes in many organs
such as the eye, brain, heart, and lung. STRA6 binds to RBP with high affinity and mediates vitamin A uptake into cells. This review summarizes the history of the RBP receptor research, its expression in the context of known functions of vitamin A in distinct human organs, structure/function analysis of this new type of membrane receptor, pertinent questions regarding its very existence, and its potential implication in treating human diseases.

Choroid plexus dysfunction impairs beta-amyloid clearance in a triple transgenic mouse model of Alzheimer’s disease

Ibrahim González-Marrero, Lydia Giménez-Llort, Conrad E. Johanson, et al.
Front Cell Neurosc  Feb2015; 9(17): 1-10
http://dx.doi.org:/10.3389/fncel.2015.00017

Compromised secretory function of choroid plexus (CP) and defective cerebrospinal fluid (CSF) production, along with accumulation of beta-amyloid (Aβ) peptides at the blood-CSF barrier (BCSFB), contribute to complications of Alzheimer’s disease (AD). The AD triple transgenic mouse model (3xTg-AD) at 16 month-old mimics critical hallmarks of the human disease: β-amyloid (Aβ) plaques and neurofibrillary tangles (NFT) with a temporal-and regional-specific profile. Currently, little is known about transport and metabolic responses by CP to the disrupted homeostasis of CNS Aβ in AD. This study analyzed the effects of highly-expressed AD-linked human transgenes (APP, PS1 and tau) on lateral ventricle CP function. Confocal imaging and immunohistochemistry revealed an increase only of Aβ42 isoform in epithelial cytosol and in stroma surrounding choroidal capillaries; this buildup may reflect insufficient clearance transport from CSF to blood. Still, there was increased expression, presumably compensatory, of the choroidal Aβ transporters: the low density lipoprotein receptor-related protein1 (LRP1) and the receptor for advanced glycation end product (RAGE). A thickening of the epithelial basal membrane and greater collagen-IV deposition occurred around capillaries in CP, probably curtailing solute exchanges. Moreover, there was attenuated expression of epithelial aquaporin-1 and transthyretin(TTR) protein compared to Non-Tg mice. Collectively these findings indicate CP dysfunction hypothetically linked to increasing Aβ burden resulting in less efficient ion transport, concurrently with reduced production of CSF (less sink action on brain Aβ) and diminished secretion of TTR (less neuroprotection against cortical Aβ toxicity). The putative effects of a disabled CP-CSF system on CNS functions are discussed in the context of AD.

Endoplasmic reticulum: The unfolded protein response is tangled In neurodegeneration

Jeroen J.M. Hoozemans, Wiep Scheper
Intl J Biochem & Cell Biology 44 (2012) 1295–1298
http://dx.doi.org/10.1016/j.biocel.2012.04.023

Organelle facts•The ER is involved in the folding and maturation ofmembrane-bound and secreted proteins.•The ER exerts protein quality control to ensure correct folding and to detect and remove misfolded proteins.•Disturbance of ER homeostasis leads to protein misfolding and induces the UPR.•Activation of the UPR is aimed to restore proteostasis via an intricate transcriptional and (post)translational signaling network.•In neurodegenerative diseases classified as tauopathies the activation of the UPR coincides with the pathogenic accumulation of the microtubule associated protein tau.•The involvement of the UPR in tauopathies makes it a potential therapeutic target.

The endoplasmic reticulum (ER) is involved in the folding and maturation of membrane-bound and secreted proteins. Disturbed homeostasis in the ER can lead to accumulation of misfolded proteins, which trigger a stress response called the unfolded protein response (UPR). In neurodegenerative diseases that are classified as tauopathies, activation of the UPR coincides with the pathogenic accumulation of the microtubule associated protein tau. Several lines of evidence indicate that UPR activation contributes to increased levels of phosphorylated tau, a prerequisite for the formation of tau aggregates. Increased understanding of the crosstalk between signaling pathways involved in protein quality control in the ERand tau phosphorylation will support the development of new therapeutic targets that promote neuronal survival.

Chemical and/or biological therapeutic strategies to ameliorate protein misfolding diseases

Derrick Sek Tong Ong and Jeffery W Kelly
Current Opin Cell Biol 2011; 23:231–238
http://dx.doi.org:/10.1016/j.ceb.2010.11.002

Inheriting a mutant misfolding-prone protein that cannot be efficiently folded in a given cell type(s) results in a spectrum of human loss-of-function misfolding diseases. The inability of the biological protein maturation pathways to adapt to a specific misfolding-prone protein also contributes to pathology. Chemical and biological therapeutic strategies are presented that restore protein homeostasis, or proteostasis, either by enhancing the biological capacity of the proteostasis network or through small molecule stabilization of a specific misfolding-prone protein. Herein, we review the recent literature on therapeutic strategies to ameliorate protein misfolding diseases that function through either of these mechanisms, or a combination thereof, and provide our perspective on the promise of alleviating protein misfolding diseases by taking advantage of proteostasis adaptation.

Read Full Post »