Air pollution increases the risk of diabetes

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Air pollution has been dominating headlines in the past few days and has been at an all time high in Delhi. The air quality in Delhi continues to remain in the severe category with no respite. There is increasing evidence for the role of environment in pathogenesis in many diseases with air pollution emerging as the largest environmental health risk globally. Exposure to the toxic air can affect the lungs blood vascular system brain and the heart leading to significant adverse health effects and associated high overall morbidity and mortality. Environmental pollution with traffic associated pollutants gaseous nitrogen dioxide especially high particulate matter PM 2.5 exposure has been linked with risk of incident diabetes. Several studies have shown a positive association between long term exposure to air pollution and increased risk of type 2 diabetes. Individuals who have prediabetes are especially vulnerable to the effects of air pollution. According to the WHO the air content of PM2.5 should be less than 10 956 g m3 but in India the levels are always more than 60 956 g m3 as 60 956 g m3 concentration has been accepted as normal in India. That means that an Indian is already six times more exposed to PM2.5. However recently extremely high levels of PM2.5 crossing 400 have been recorded. The risk of future diabetes associated with exposure to 10 956 g cu mm increase of PM2.5 ranges between 10 and 27 Endocrine. 2016 Jan 51 1 32 7 . Any particulate matter of less than 2.5 m in size can get absorbed from respiratory system enter into the blood. The exact mechanisms as to how air pollution causes diabetes Air pollutants are hypothesized to exert their effects via impaired endothelial function elevated systemic inflammation mitochondrial dysfunction and oxidative stress all of which are hallmarks of type 2 diabetes Trends Endocrinol Metab. 2015 Jul 26 7 384 94 . Increased oxidative stress leads to insulin resistance 946 cell dysfunction impaired glucose tolerance and ultimately type 2 diabetes. India has the second highest number of people living with diabetes 69.2 million with a prevalence of 8.7 . China has the highest number of people living with diabetes with 109 million cases of diabetes in the year 2015 and a prevalence of 10.6 . This scenario calls for high priority action to minimize the air pollution to contain the rising incidence of type 2 diabetes in the country. The responsibility towards this end lies with each one of us as it does with the government.

Air pollution causes millions of CKD cases globally each year

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The estimated global burden of chronic kidney disease CKD attributable to air pollution fine particulate matter PM less than 2.5 m is significant amounting to more than 10.7 million cases per year. The researchers used the Global Burden of Disease study methodologies to estimate the burden of CKD attributable to air pollution. Epidemiologic measures of the burden of CKD attributable to air pollution included years living with disability YLD meaning years living with kidney disease years of life lost YLL meaning early death attributable to kidney disease and disability adjusted life years DALY a measure that combines the burden of living with the disease and the early death caused by the disease . The global annual burden of incident CKD attributable to high PM2.5 levels was 10 784 514 95 Uncertainty Interval 7 821 109 13 857 623 . YLD YLL and DALYs of CKD attributable to high PM2.5 were 2 185 317 1 418 442 3 061 477 7 897 941 5 471 081 10 514 433 and 10 083 258 7 064 399 13 323 685 respectively. The study also found that burden of disease varies greatly by geography. India along with Nigeria Bangladesh and Pakistan had the high attributable burden of disease exceeding 200 incident cases of CKD per 100 000 population. India was also amongst the countries that reported highest DALYs that included Mexico Central America Southeast Asia and Northern Africa. DALYs per 100 000 were 366.71 251.05 498.01 in Nicaragua and 353.93 260.05 449.24 in Mexico compared to 44.59 24.07 65.74 in the United States. These findings were presented at the recently concluded ASN Kidney Week 2017 in New Orleans Louisiana USA. Keeping BP cholesterol body weight blood sugar within healthy limits avoiding overuse of OTC painkillers smoking eating a healthy diet and exercising regularly are some of the ways to protect kidney health. Air pollution has become a major threat to society today. Air pollution has been at an extremely high level particularly in the Delhi NCR region and continues to remain the hazardous category. Studies have shown that air pollution can damage the kidneys. A significant association between exposure to PM2.5 and risk of incident CKD decrease in estimated glomerular filtration rate eGFR and progression to end stage renal disease was reported online September 2 2017 in the Journal of the American Society of Nephrology. It s now time perhaps to add air pollution PM2.5 to the list of risk factors for chronic kidney disease and recommend avoiding or limiting air pollution exposure to the list of measures generally advised to prevent delay chronic kidney disease. It has become important to also note the air pollution levels in different areas in your city before venturing out to avoid exposure to pollution. Source American Society of Nephrology News Release November 4 2017

Not just the government, citizens too share the responsibility to control pollution

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Air pollution has often been in the news especially since the last few years. Evidences of the harmful effects of air pollution on public health are accumulating. And each time the Air Quality Index AQI crosses the red zone indicating very poor or severe air quality much is written about or talked about to ascribe blame for this rise in pollution to hazardous levels. The pollution levels increased to severe levels this year too in the National Capital Region NCR post Diwali. This was despite the ban on the sale of firecrackers in NCR by the Supreme Court of India. Such high levels of pollution are not only harmful to people with existing disease but also for healthy individuals. This situation should give us all pause to think. It is easy and very convenient to be on the sidelines and fault find the government for its apathy or lack of stringent measures to bring down the pollution levels. And it s not just air pollution noise pollution and water pollution are also a serious cause for concern. Ask not what your country can do for you ask what you can do for your country . These historic words from President John F Kennedy though addressed to the citizens of the United States also challenge us to act for the betterment of the society we live in. Instead of always pointing an accusatory finger at the government we should introspect and ask ourselves Am I really a responsible citizen Preventing and controlling pollution is not the sole responsibility of the government. Most of existing pollution levels are man made so we also must contribute in the efforts to control pollution. It is the moral duty of each one of us as active members of the society to adopt measures to help control pollution. As responsible citizens we must respect laws of the state in place and abide by them. We must make individual efforts to control pollution. Here are some simple steps that each one of us can take to help reduce pollution. More can be added to this list. I will not burn agarbatti incense sticks and dhoop batti at my home or workplace till pollution levels drop. I will not burn flame producing candles. I will not use kerosene oil for any purpose. I will avoid using polythene bags or plastic. I will use products which can be recycled as much as possible. I will not use wood and coal for any purpose be it cooking or heating. If any unfortunate death occurs in my family I will bravely opt for electric cremation. I will not smoke cigarettes beedis nor allow anyone else too. I will resort to wet mopping the floors in my house and workplace. Wherever possible I will practice carpooling. I will opt for public transportation as much as possible. I will regularly get my vehicle s checked for pollution standards and serviced so that it is in good condition. I will walk or cycle for short distance commutes. I will make sure that the ACs at my home vehicle workplace do not have a choked filter. If yes I will regularly get the AC checked and serviced as scheduled. I will check air purifiers at my home and workplace for choked filters and replace them if necessary. I will not burn leaves garbage paper waste. I will raise my voice against air pollution. If at a petrol pump I see no mechanism for absorbing toxic vapors I will speak up. I will not allow construction material to linger on roads after the work is finished. I will insist that the roads in my vicinity are cleaned only mechanically between 12 pm to 5 am. I will talk to my RWA to plant more trees. I will sell my diesel car and buy a CNG one. I will avidly vote for heavy taxes on crackers and tobacco. I will educate people every day to avoid contributing to air pollution and how to avoid pollutant exposure. Answer yes to most of the above if not all to do your bit and make your significant contribution. You will find that 90 of these are a matter of personal choice. Only about 10 factors are beyond one s control. Not just the government each one of us has a civic responsibility and the contribution from each of us no matter however small has an impact. Every little step taken at the individual level will only work towards the goodwill of the society as a whole. Disclaimer The views expressed in this write up are entirely my own.

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