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Health Technology Assessment... Dec 2023The aim of the study was to investigate the potential effect of different structural interventions for preventing cardiovascular disease.
BACKGROUND
The aim of the study was to investigate the potential effect of different structural interventions for preventing cardiovascular disease.
METHODS
Medline and EMBASE were searched for peer-reviewed simulation-based studies of structural interventions for prevention of cardiovascular disease. We performed a systematic narrative synthesis.
RESULTS
A total of 54 studies met the inclusion criteria. Diet, nutrition, tobacco and alcohol control and other programmes are among the policy simulation models explored. Food tax and subsidies, healthy food and lifestyles policies, palm oil tax, processed meat tax, reduction in ultra-processed foods, supplementary nutrition assistance programmes, stricter food policy and subsidised community-supported agriculture were among the diet and nutrition initiatives. Initiatives to reduce tobacco and alcohol use included a smoking ban, a national tobacco control initiative and a tax on alcohol. Others included the NHS Health Check, WHO 25 × 25 and air quality management policy.
FUTURE WORK AND LIMITATIONS
There is significant heterogeneity in simulation models, making comparisons of output data impossible. While policy interventions typically include a variety of strategies, none of the models considered possible interrelationships between multiple policies or potential interactions. Research that investigates dose-response interactions between numerous modifications as well as longer-term clinical outcomes can help us better understand the potential impact of policy-level interventions.
CONCLUSIONS
The reviewed studies underscore the potential of structural interventions in addressing cardiovascular diseases. Notably, interventions in areas such as diet, tobacco, and alcohol control demonstrate a prospective decrease in cardiovascular incidents. However, to realize the full potential of such interventions, there is a pressing need for models that consider the interplay and cumulative impacts of multiple policies. Rigorous research into holistic and interconnected interventions will pave the way for more effective policy strategies in the future.
STUDY REGISTRATION
The study is registered as PROSPERO CRD42019154836.
FUNDING
This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/148/05.
PubMed: 38140927
DOI: 10.3310/NMFG0214 -
The Cochrane Database of Systematic... May 2023Since December 2019, the world has struggled with the COVID-19 pandemic. Even after the introduction of various vaccines, this disease still takes a considerable toll.... (Review)
Review
BACKGROUND
Since December 2019, the world has struggled with the COVID-19 pandemic. Even after the introduction of various vaccines, this disease still takes a considerable toll. In order to improve the optimal allocation of resources and communication of prognosis, healthcare providers and patients need an accurate understanding of factors (such as obesity) that are associated with a higher risk of adverse outcomes from the COVID-19 infection.
OBJECTIVES
To evaluate obesity as an independent prognostic factor for COVID-19 severity and mortality among adult patients in whom infection with the COVID-19 virus is confirmed.
SEARCH METHODS
MEDLINE, Embase, two COVID-19 reference collections, and four Chinese biomedical databases were searched up to April 2021.
SELECTION CRITERIA
We included case-control, case-series, prospective and retrospective cohort studies, and secondary analyses of randomised controlled trials if they evaluated associations between obesity and COVID-19 adverse outcomes including mortality, mechanical ventilation, intensive care unit (ICU) admission, hospitalisation, severe COVID, and COVID pneumonia. Given our interest in ascertaining the independent association between obesity and these outcomes, we selected studies that adjusted for at least one factor other than obesity. Studies were evaluated for inclusion by two independent reviewers working in duplicate. DATA COLLECTION AND ANALYSIS: Using standardised data extraction forms, we extracted relevant information from the included studies. When appropriate, we pooled the estimates of association across studies with the use of random-effects meta-analyses. The Quality in Prognostic Studies (QUIPS) tool provided the platform for assessing the risk of bias across each included study. In our main comparison, we conducted meta-analyses for each obesity class separately. We also meta-analysed unclassified obesity and obesity as a continuous variable (5 kg/m increase in BMI (body mass index)). We used the GRADE framework to rate our certainty in the importance of the association observed between obesity and each outcome. As obesity is closely associated with other comorbidities, we decided to prespecify the minimum adjustment set of variables including age, sex, diabetes, hypertension, and cardiovascular disease for subgroup analysis. MAIN RESULTS: We identified 171 studies, 149 of which were included in meta-analyses. As compared to 'normal' BMI (18.5 to 24.9 kg/m) or patients without obesity, those with obesity classes I (BMI 30 to 35 kg/m), and II (BMI 35 to 40 kg/m) were not at increased odds for mortality (Class I: odds ratio [OR] 1.04, 95% confidence interval [CI] 0.94 to 1.16, high certainty (15 studies, 335,209 participants); Class II: OR 1.16, 95% CI 0.99 to 1.36, high certainty (11 studies, 317,925 participants)). However, those with class III obesity (BMI 40 kg/m and above) may be at increased odds for mortality (Class III: OR 1.67, 95% CI 1.39 to 2.00, low certainty, (19 studies, 354,967 participants)) compared to normal BMI or patients without obesity. For mechanical ventilation, we observed increasing odds with higher classes of obesity in comparison to normal BMI or patients without obesity (class I: OR 1.38, 95% CI 1.20 to 1.59, 10 studies, 187,895 participants, moderate certainty; class II: OR 1.67, 95% CI 1.42 to 1.96, 6 studies, 171,149 participants, high certainty; class III: OR 2.17, 95% CI 1.59 to 2.97, 12 studies, 174,520 participants, high certainty). However, we did not observe a dose-response relationship across increasing obesity classifications for ICU admission and hospitalisation.
AUTHORS' CONCLUSIONS
Our findings suggest that obesity is an important independent prognostic factor in the setting of COVID-19. Consideration of obesity may inform the optimal management and allocation of limited resources in the care of COVID-19 patients.
Topics: Adult; Humans; Pandemics; Prospective Studies; Retrospective Studies; COVID-19; Risk Factors; Obesity
PubMed: 37222292
DOI: 10.1002/14651858.CD015201 -
TheScientificWorldJournal 2022Palm oil production has increased significantly, specifically in Indonesia and Malaysia. However, this growth has raised environmental concerns due to the high discharge... (Review)
Review
Palm oil production has increased significantly, specifically in Indonesia and Malaysia. However, this growth has raised environmental concerns due to the high discharge of empty fruit bunches, palm oil mill effluents, and other solid wastes. Therefore, this study aims to examine the treatment of palm oil waste by composting and systematically review insights into its application through a systematic literature review approach. Among the 1155 articles, a total of 135 were selected for a systematic review of palm oil waste management developments and their applications, while 14 were used for determining compost quality according to the criteria and requirements established in the systematic literature review. Moreover, using Egger's test, JAMOVI 1.6.23 software was used to analyze random effects models with 95% confidence intervals and publication bias. The results showed that palm oil waste was optimally treated by composting, which is considered as a sustainable technology for protecting the environment, human safety, and economic value. The in-vessel method with a controlled composting chamber is the best system with a minimum time of 14 days. However, it requires tight control and provides a final product with a high microbial colony form outdoors and indoors compared to the windrow system. This study is useful to see the bias of research results and helps to find new studies that need to be developed, especially in this case related to the management of palm oil waste into organic compost fertilizer and its application methods in the field. It is suggested that applying palm oil waste or compost is mainly performed by mulching. In contrast, new challenges for better processing to produce organic fertilizers and applicable technologies for sustainable waste management are recommended. The method must be affordable, efficient, and practical, combining compost quality with maximum nutrient recovery.
Topics: Humans; Composting; Palm Oil; Soil; Waste Management; Fertilizers
PubMed: 36408196
DOI: 10.1155/2022/5073059 -
Heliyon Oct 2022This paper reviews previous research on the sustainability and policies of palm oil-based bioenergy in Indonesia and Malaysia. A systematic literature review with a...
This paper reviews previous research on the sustainability and policies of palm oil-based bioenergy in Indonesia and Malaysia. A systematic literature review with a meta-analysis (PRISMA) methodology was performed to evaluate the related articles discussing sustainability and bioenergy policies. This study found 96 articles that mapped the sustainability and policies of bioenergy in Indonesia and Malaysia over the last decade. The sustainability studies were divided into two areas: the environment and socioeconomics. Researchers were more likely to examine environmental factors than socioeconomic factors, specifically focusing on the following environmental indicators: land use conversion, deforestation, and CO emissions. Most policy studies concentrated on sustainability and energy security. Over the last two decades, the development of bioenergy policies in Indonesia and Malaysia has been comparable in terms of geographical position and palm oil production. However, Indonesia's bioenergy policy has tended to be more vigorous and dynamic than Malaysia.
PubMed: 36247150
DOI: 10.1016/j.heliyon.2022.e10919 -
The Cochrane Database of Systematic... Aug 2022Elevated blood pressure, or hypertension, is the leading cause of preventable deaths globally. Diets high in sodium (predominantly sodium chloride) and low in potassium... (Review)
Review
BACKGROUND
Elevated blood pressure, or hypertension, is the leading cause of preventable deaths globally. Diets high in sodium (predominantly sodium chloride) and low in potassium contribute to elevated blood pressure. The WHO recommends decreasing mean population sodium intake through effective and safe strategies to reduce hypertension and its associated disease burden. Incorporating low-sodium salt substitutes (LSSS) into population strategies has increasingly been recognised as a possible sodium reduction strategy, particularly in populations where a substantial proportion of overall sodium intake comes from discretionary salt. The LSSS contain lower concentrations of sodium through its displacement with potassium predominantly, or other minerals. Potassium-containing LSSS can potentially simultaneously decrease sodium intake and increase potassium intake. Benefits of LSSS include their potential blood pressure-lowering effect and relatively low cost. However, there are concerns about potential adverse effects of LSSS, such as hyperkalaemia, particularly in people at risk, for example, those with chronic kidney disease (CKD) or taking medications that impair potassium excretion.
OBJECTIVES
To assess the effects and safety of replacing salt with LSSS to reduce sodium intake on cardiovascular health in adults, pregnant women and children.
SEARCH METHODS
We searched MEDLINE (PubMed), Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection (Clarivate Analytics), Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCOhost), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) up to 18 August 2021, and screened reference lists of included trials and relevant systematic reviews. No language or publication restrictions were applied.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and prospective analytical cohort studies in participants of any age in the general population, from any setting in any country. This included participants with non-communicable diseases and those taking medications that impair potassium excretion. Studies had to compare any type and method of implementation of LSSS with the use of regular salt, or no active intervention, at an individual, household or community level, for any duration.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened titles, abstracts and full-text articles to determine eligibility; and extracted data, assessed risk of bias (RoB) using the Cochrane RoB tool, and assessed the certainty of the evidence using GRADE. We stratified analyses by adults, children (≤ 18 years) and pregnant women. Primary effectiveness outcomes were change in diastolic and systolic blood pressure (DBP and SBP), hypertension and blood pressure control; cardiovascular events and cardiovascular mortality were additionally assessed as primary effectiveness outcomes in adults. Primary safety outcomes were change in blood potassium, hyperkalaemia and hypokalaemia.
MAIN RESULTS
We included 26 RCTs, 16 randomising individual participants and 10 randomising clusters (families, households or villages). A total of 34,961 adult participants and 92 children were randomised to either LSSS or regular salt, with the smallest trial including 10 and the largest including 20,995 participants. No studies in pregnant women were identified. Studies included only participants with hypertension (11/26), normal blood pressure (1/26), pre-hypertension (1/26), or participants with and without hypertension (11/26). This was unknown in the remaining studies. The largest study included only participants with an elevated risk of stroke at baseline. Seven studies included adult participants possibly at risk of hyperkalaemia. All 26 trials specifically excluded participants in whom an increased potassium intake is known to be potentially harmful. The majority of trials were conducted in rural or suburban settings, with more than half (14/26) conducted in low- and middle-income countries. The proportion of sodium chloride replacement in the LSSS interventions varied from approximately 3% to 77%. The majority of trials (23/26) investigated LSSS where potassium-containing salts were used to substitute sodium. In most trials, LSSS implementation was discretionary (22/26). Trial duration ranged from two months to nearly five years. We assessed the overall risk of bias as high in six trials and unclear in 12 trials. LSSS compared to regular salt in adults: LSSS compared to regular salt probably reduce DBP on average (mean difference (MD) -2.43 mmHg, 95% confidence interval (CI) -3.50 to -1.36; 20,830 participants, 19 RCTs, moderate-certainty evidence) and SBP (MD -4.76 mmHg, 95% CI -6.01 to -3.50; 21,414 participants, 20 RCTs, moderate-certainty evidence) slightly. On average, LSSS probably reduce non-fatal stroke (absolute effect (AE) 20 fewer/100,000 person-years, 95% CI -40 to 2; 21,250 participants, 3 RCTs, moderate-certainty evidence), non-fatal acute coronary syndrome (AE 150 fewer/100,000 person-years, 95% CI -250 to -30; 20,995 participants, 1 RCT, moderate-certainty evidence) and cardiovascular mortality (AE 180 fewer/100,000 person-years, 95% CI -310 to 0; 23,200 participants, 3 RCTs, moderate-certainty evidence) slightly, and probably increase blood potassium slightly (MD 0.12 mmol/L, 95% CI 0.07 to 0.18; 784 participants, 6 RCTs, moderate-certainty evidence), compared to regular salt. LSSS may result in little to no difference, on average, in hypertension (AE 17 fewer/1000, 95% CI -58 to 17; 2566 participants, 1 RCT, low-certainty evidence) and hyperkalaemia (AE 4 more/100,000, 95% CI -47 to 121; 22,849 participants, 5 RCTs, moderate-certainty evidence) compared to regular salt. The evidence is very uncertain about the effects of LSSS on blood pressure control, various cardiovascular events, stroke mortality, hypokalaemia, and other adverse events (very-low certainty evidence). LSSS compared to regular salt in children: The evidence is very uncertain about the effects of LSSS on DBP and SBP in children. We found no evidence about the effects of LSSS on hypertension, blood pressure control, blood potassium, hyperkalaemia and hypokalaemia in children.
AUTHORS' CONCLUSIONS
When compared to regular salt, LSSS probably reduce blood pressure, non-fatal cardiovascular events and cardiovascular mortality slightly in adults. However, LSSS also probably increase blood potassium slightly in adults. These small effects may be important when LSSS interventions are implemented at the population level. Evidence is limited for adults without elevated blood pressure, and there is a lack of evidence in pregnant women and people in whom an increased potassium intake is known to be potentially harmful, limiting conclusions on the safety of LSSS in the general population. We also cannot draw firm conclusions about effects of non-discretionary LSSS implementations. The evidence is very uncertain about the effects of LSSS on blood pressure in children.
Topics: Adult; Child; Female; Humans; Hyperkalemia; Hypertension; Hypokalemia; Potassium; Pregnancy; Pregnant Women; Randomized Controlled Trials as Topic; Sodium; Sodium Chloride; Sodium Chloride, Dietary; Stroke
PubMed: 35944931
DOI: 10.1002/14651858.CD015207 -
Environmental Science and Pollution... May 2022
PubMed: 35389171
DOI: 10.1007/s11356-022-19547-7 -
Pharmaceuticals (Basel, Switzerland) Sep 2021The oil palm tree ( Jacq.) originates from West and Central Africa, and it is cultivated in Malaysia for its oil-producing fruits. Malaysia is the world's second largest... (Review)
Review
The oil palm tree ( Jacq.) originates from West and Central Africa, and it is cultivated in Malaysia for its oil-producing fruits. Malaysia is the world's second largest palm oil producer and the world's largest exporter to date. Consequently, the Malaysian oil palm industry constantly generates a huge amount of biomass with the major contributor being the leaves. A large percentage of these leaves remain underutilized, making them a promising source of raw materials that can be converted into value-added products. The present review summarizes and discusses the flavonoid composition, total phenolic and flavonoid content, and the in vitro and in vivo pharmacological properties exhibited by the extracts of the leaves of . The purpose of this systematic review is to highlight the potential of valorizing the leaf extracts of the oil palm tree as pharmaceutical and cosmeceutical agents.
PubMed: 34681185
DOI: 10.3390/ph14100961 -
Materials (Basel, Switzerland) Aug 2021Several agro-waste materials have been utilized for sustainable engineering and environmental application over the past decades, showing different degrees of... (Review)
Review
Several agro-waste materials have been utilized for sustainable engineering and environmental application over the past decades, showing different degrees of effectiveness. However, information concerning the wider use of palm oil clinker (POC) and its performance is still lacking. Therefore, as a solid waste byproduct produced in one of the oil palm processing stages, generating a huge quantity of waste mostly dumped into the landfill, the waste-to-resource potential of POC should be thoroughly discussed in a review. Thus, this paper provides a systematic review of the current research articles on the several advances made from 2005 to 2021 regarding palm oil clinker physical properties and performances, with a particular emphasis on their commitments to cost savings during environmental and engineering applications. The review begins by identifying the potential of POC application in conventional and geopolymer structural elements such as beams, slabs, and columns made of concrete, mortar, or paste for coarse aggregates, sand, and cement replacement. Aspects such as performance of POC in wastewater treatment processes, fine aggregate and cement replacement in asphaltic and bituminous mixtures during highway construction, a bio-filler in coatings for steel manufacturing processes, and a catalyst during energy generation are also discussed. This review further describes the effectiveness of POC in soil stabilization and the effect of POC pretreatment for performance enhancement. The present review can inspire researchers to find research gaps that will aid the sustainable use of agroindustry wastes. The fundamental knowledge contained in this review can also serve as a wake-up call for researchers that will motivate them to explore the high potential of utilizing POC for greater environmental benefits associated with less cost when compared with conventional materials.
PubMed: 34442978
DOI: 10.3390/ma14164456 -
Environmental Science and Pollution... Oct 2021The interaction and the interplay of climate change with oil palm production in the Southeast Asia region are of serious concern. This particularly applies in Malaysia... (Review)
Review
The interaction and the interplay of climate change with oil palm production in the Southeast Asia region are of serious concern. This particularly applies in Malaysia due to its rank as the second largest palm oil producer in the world. The anthropogenic activities and the agroecological practices in oil palm plantation, including excessive use of fertilisers, bush fire due to land clearing, and cultivation on peatland, have exacerbated the effects of climate change featuring extreme events, drought, flooding, heatwave, as well as infestation of pest and diseases. These adverse impacts on oil palm production highlight the significance of deploying effective adaptation strategies. The study aims to examine the impact of climate change on oil palm production and identify the farmers' adaptation strategies to the impacts of climate change in Malaysia. This study was conducted a comprehensive review of the articles published from 2000 to 2021 in the contexts of climate change and oil palm production in Malaysia. The review shows that climate change has a range of impacts on the oil palm production in Malaysia. As a result, several adaptation options were identified, such as breeding of hybrid varieties that are tolerant and resistant to heat; sustainable management of soil; pit and tranches to enhance water management in plantation areas; minimal use of fertilisers, herbicides, and pesticides; zero burning; and minimum tillage. The reviewed studies recommended the following to mitigate the adverse impacts of climate change: sustainable national policy on climate change, conservation of the existing carbon stock, effective management of tropical rainforest biodiversity, afforestation for carbon sequestration, and reduction in greenhouse gas (GHG) emission.
Topics: Climate Change; Malaysia
PubMed: 34402002
DOI: 10.1007/s11356-021-15890-3 -
Asia Pacific Journal of Clinical... 2020Current guidelines recommend reducing intake of diets rich in saturated fats and replacing it with diets rich in unsaturated fats. Palm oil contains a high amount of... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
Current guidelines recommend reducing intake of diets rich in saturated fats and replacing it with diets rich in unsaturated fats. Palm oil contains a high amount of saturated fatty acids, but its effect on serum lipid levels is unclear. The study aimed to compare the effects of palm oil consumption with other edible oils rich in monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) on serum lipid profiles.
METHODS AND STUDY DESIGN
We searched Medline, Embase, Cochrane Central Registry of Controlled Trials and CINAHL. Clinical trials were eligible if they compared palm oil-rich diets with diets rich in MUFAs or PUFAs. We pooled results of included studies using a random effects model and assessed the quality of the evidence and certainty of conclusions using the GRADE approach.
RESULTS
Intake of palm oil intake compared to oils rich in MUFA was associated with increased levels of total cholesterol (TC) [mean difference (MD)=0.27 mmol/L; 95% CI 0.08 to 0.45], LDL-C (MD=0.20 mmol/L; 95% CI 0.02 to 0.37) and HDL-C (MD=0.06 mmol/L; 95% CI 0.02 to 0.10). Similarly, for comparison with oils rich in PUFAs, palm oil showed increased in TC (MD=0.38 mmol/L; 95% CI 0.14 to 0.62), LDL-C (MD= 0.44 mmol/L; 95% CI 0.01 to 0.88) and HDL-C (MD=0.08 mmol/L; 95% CI 0.03 to 0.13). For both comparisons, there were no significant effects on triglycerides.
CONCLUSIONS
Even though palm oil increases marginally the level of serum lipids, the evidence is mostly of low to moderate quality.
Topics: Diet; Dietary Fats; Humans; Lipids; Palm Oil
PubMed: 32990612
DOI: 10.6133/apjcn.202009_29(3).0011