Fortis Healthcare

About: Fortis Healthcare is a healthcare organization based out in Delhi, India. It is known for research contribution in the topics: Population & Medicine. The organization has 1149 authors who have published 1327 publications receiving 14178 citations.

Childhood Obesity in Developing Countries: Epidemiology, Determinants, and Prevention

Abstract: Rapidly changing dietary practices and a sedentary lifestyle have led to increasing prevalence of childhood obesity (5-19 yr) in developing countries recently: 41.8% in Mexico, 22.1% in Brazil, 22.0% in India, and 19.3% in Argentina. Moreover, secular trends indicate increasing prevalence rates in these countries: 4.1 to 13.9% in Brazil during 1974-1997, 12.2 to 15.6% in Thailand during 1991-1993, and 9.8 to 11.7% in India during 2006-2009. Important determinants of childhood obesity include high socioeconomic status, residence in metropolitan cities, female gender, unawareness and false beliefs about nutrition, marketing by transnational food companies, increasing academic stress, and poor facilities for physical activity. Childhood obesity has been associated with type 2 diabetes mellitus, the early-onset metabolic syndrome, subclinical inflammation, dyslipidemia, coronary artery diseases, and adulthood obesity. Therapeutic lifestyle changes and maintenance of regular physical activity through parental initiative and social support interventions are the most important strategies in managing childhood obesity. Also, high-risk screening and effective health educational programs are urgently needed in developing countries.

Obesity-related non-communicable diseases: South Asians vs White Caucasians

Abstract: South Asians are at higher risk than White Caucasians for the development of obesity and obesity-related non-communicable diseases (OR-NCDs), including insulin resistance, the metabolic syndrome, type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD). Rapid nutrition and lifestyle transitions have contributed to acceleration of OR-NCDs in South Asians. Differences in determinants and associated factors for OR-NCDs between South Asians and White Caucasians include body phenotype (high body fat, high truncal, subcutaneous and intra-abdominal fat, and low muscle mass), biochemical parameters (hyperinsulinemia, hyperglycemia, dyslipidemia, hyperleptinemia, low levels of adiponectin and high levels of C-reactive protein), procoagulant state and endothelial dysfunction. Higher prevalence, earlier onset and increased complications of T2DM and CHD are often seen at lower levels of body mass index (BMI) and waist circumference (WC) in South Asians than White Caucasians. In view of these data, lower cut-offs for obesity and abdominal obesity have been advocated for Asian Indians (BMI; overweight >23 to 24.9 kg m(-2) and obesity ≥ 25 kg m(-2); and WC; men ≥ 90 cm and women ≥ 80 cm, respectively). Imbalanced nutrition, physical inactivity, perinatal adverse events and genetic differences are also important contributory factors. Other differences between South Asians and White Caucasians include lower disease awareness and health-seeking behavior, delayed diagnosis due to atypical presentation and language barriers, and religious and sociocultural factors. All these factors result in poorer prevention, less aggressive therapy, poorer response to medical and surgical interventions, and higher morbidity and mortality in the former. Finally, differences in response to pharmacological agents may exist between South Asians and White Caucasians, although these have been inadequately studied. In view of these data, prevention and management strategies should be more aggressive for South Asians for more positive health outcomes. Finally, lower cut-offs of obesity and abdominal obesity for South Asians are expected to help physicians in better and more effective prevention of OR-NCDs.

The metabolic syndrome in South Asians: epidemiology, determinants, and prevention.

Abstract: Background: The prevalence of obesity and the metabolic syndrome is rapidly increasing in India and other south Asian countries, leading to increased morbidity and mortality due to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Methods: The literature search has been carried out using the key words “insulin resistance, the metabolic syndrome, cardiovascular risk, diabetes, obesity, Asian Indians, and South Asians” in the medical search engine Pubmed (National Library of Medicine, Bethesda, MD) from 1966 to September 2009. Results: A high prevalence of the metabolic syndrome and associated cardiovascular risk factors has been observed not only in urban South Asian/Asian Indian adults and children but also in economically disadvantaged people residing in urban slums and rural areas. The main drivers are rapid nutrition, lifestyle, and socioeconomic transitions, consequent to increasing affluence, urbanization, mechanization, and rural-to-urban migration. Less investigated determinants of ...

3rd ESO–ESMO international consensus guidelines for Advanced Breast Cancer (ABC 3)

Abstract: For the purpose of advanced breast cancer (ABC) guidelines, ABC comprises both inoperable locally advanced breast cancer (LABC) and metastatic breast cancer (MBC)1 , 2 Advanced/metastatic breast cancer remains a virtually incurable disease, with a median overall survival (OS) of about 3 years and a 5-year survival rate of around 25%,3 , 4 even in countries without major accessibility problems Survival is strongly related to breast cancer subtype, with the major advances seen in human epidermal growth factor receptor 2 (HER2)-positive ABC5, 6, 7, 8, 9 ABC is a treatable disease with several available therapies and many others in development However, their impact on survival and quality of life (QoL) of ABC patients has been slow3 and different for de novo versus recurrent ABC, with the latter becoming much harder to treat in recent years10 Outcomes are also strongly related to access to the best available care, which includes not only the most efficacious medicines, but also multidisciplinary, specialised care, implementation of guidelines, high-quality pathology, imaging and radiotherapy (RT) Lack of any of these crucial pillars of modern oncological care inevitably results in substantially worse outcomes, as exemplified in the New Zealand report “I am still here”11 While mortality rates have decreased in the majority of developed countries, most deaths are currently seen in less developed societies, and access issues explain the majority of these inequalities12 The application of the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS)13 to the field of ABC (P Shimon, personal communication) shows that the quality of clinical research has improved over the last decade and that better therapies have been developed, providing hope that a substantial improvement in the median OS of ABC patients might soon be seen However, some clinically relevant questions are still unanswered and may be difficult to address through traditional clinical trials, such as the best sequence of therapies for each individual patient The application of computer analytics to big data and real-world data is one of the potential ways forward In-depth discussion must take place regarding the impact of this ‘new’ level of evidence (LoE) in current treatment guidelines and their integration with clinical trial data The 5th International Consensus Conference for Advanced Breast Cancer (ABC 5) took place in Lisbon, Portugal, on 14th-16th November 2019, bringing together 1500 participants from 94 countries worldwide, including health professionals, patient advocates and journalists Since its first edition in 2011, the main goal of the ABC conference has been the development of high-quality international consensus guidelines for the management of ABC These guidelines are based on available evidence and on expert opinion when evidence is lacking They represent the best management options for ABC patients globally, assuming accessibility to all available therapies Adaptation of these guidelines is often needed in settings where access to care is suboptimal The ABC 5 guidelines are jointly developed by ESO and ESMO, and have been endorsed by several international oncology organisations, such as the European Society of Breast Cancer Specialists (EUSOMA), European Society for Radiotherapy and Oncology (ESTRO), European Society of Gynaecological Oncology (ESGO), Union for International Cancer Control (UICC), Senologic International Society (SIS)/International School of Senology (ISS), Federacion Latino-Americana de Mastologia (FLAM), European Oncology Nursing Society (EONS), European Society of Surgical Oncology (ESSO), Arbeitsgemeinschaft Gynakologische Onkologie eV (AGO) and the International Society of Geriatric Oncology (SIOG), and have official representation from the American Society of Clinical Oncology (ASCO) The ABC 5 conference was also organised under the auspices of the Organisation of European Cancer Institutes (OECI) and with the support of the Breast Cancer Research Foundation (BCRF), Susan G Komen and the ABC Global Alliance This manuscript summarises the guidelines developed at ABC 5, each of which are accompanied by the LoE, grade of recommendation (GoR), percentage of consensus reached at the conference and supporting references In addition, the ESMO-MCBS version 1113 (v11) was used to calculate scores for new therapies/indications approved by the European Medicines Agency (EMA) since the last ABC guidelines, as well as a few new therapies that have been scored but are still under EMA evaluation (https://wwwesmoorg/Guidelines/ESMO-MCBS) A table with these scores is included (see supplementary Table S1, available at https://doi/org/101016/jannonc202009010)