Pub Date : 2023-10-01Epub Date: 2023-09-25DOI: 10.4103/ijmr.ijmr_2105_23
Manickam Ponnaiah, Tarun Bhatnagar, Rizwan Suliankachi Abdulkader, Rajalakshmi Elumalai, Janani Surya, Kathiresan Jeyashree, Muthusamy Santhosh Kumar, Ranjithkumar Govindaraju, Jeromie Wesley Vivian Thangaraj, Hari Krishan Aggarwal, Suresh Balan, Tridip Dutta Baruah, Ayan Basu, Yogita Bavaskar, Ajeet Singh Bhadoria, Ashish Bhalla, Pankaj Bhardwaj, Rachana Bhat, Jaya Chakravarty, Gina Maryann Chandy, Bal Kishan Gupta, Rakesh Kakkar, Ali Hasan Faiz Karnam, Sushila Kataria, Janakkumar Khambholja, Dewesh Kumar, Nithin Kumar, Monaliza Lyngdoh, M Selva Meena, Kedar Mehta, M P Sheethal, Subhasis Mukherjee, Anuj Mundra, Arun Murugan, Seetharaman Narayanan, Balamurugan Nathan, Jutika Ojah, Pushpa Patil, Sunita Pawar, A Charles Pon Ruban, R Vadivelu, Rishabh Kumar Rana, S Nagendra Boopathy, S Priya, Saroj Kumar Sahoo, Arti Shah, Mohammad Shameem, Karthikeyan Shanmugam, Sachin K Shivnitwar, Abhishek Singhai, Saurabh Srivastava, Sudheera Sulgante, Arunansu Talukdar, Alka Verma, Rajaat Vohra, Rabbanie Tariq Wani, Bhargavi Bathula, Gayathri Kumari, Divya Saravana Kumar, Aishwariya Narasimhan, N C Krupa, Thirumaran Senguttuvan, Parvathi Surendran, Dharsikaa Tamilmani, Alka Turuk, Gunjan Kumar, Aparna Murkherjee, Rakesh Aggarwal, Manoj Vasant Murhekar
Background objectives: In view of anecdotal reports of sudden unexplained deaths in India's apparently healthy young adults, linking to coronavirus disease 2019 (COVID-19) infection or vaccination, we determined the factors associated with such deaths in individuals aged 18-45 years through a multicentric matched case-control study.
Methods: This study was conducted through participation of 47 tertiary care hospitals across India. Cases were apparently healthy individuals aged 18-45 years without any known co-morbidity, who suddenly (<24 h of hospitalization or seen apparently healthy 24 h before death) died of unexplained causes during 1 st October 2021-31 st March 2023. Four controls were included per case matched for age, gender and neighborhood. We interviewed/perused records to collect data on COVID-19 vaccination/infection and post-COVID-19 conditions, family history of sudden death, smoking, recreational drug use, alcohol frequency and binge drinking and vigorous-intensity physical activity two days before death/interviews. We developed regression models considering COVID-19 vaccination ≤42 days before outcome, any vaccine received anytime and vaccine doses to compute an adjusted matched odds ratio (aOR) with 95 per cent confidence interval (CI).
Results: Seven hundred twenty nine cases and 2916 controls were included in the analysis. Receipt of at least one dose of COVID-19 vaccine lowered the odds [aOR (95% CI)] for unexplained sudden death [0.58 (0.37, 0.92)], whereas past COVID-19 hospitalization [3.8 (1.36, 10.61)], family history of sudden death [2.53 (1.52, 4.21)], binge drinking 48 h before death/interview [5.29 (2.57, 10.89)], use of recreational drug/substance [2.92 (1.1, 7.71)] and performing vigorous-intensity physical activity 48 h before death/interview [3.7 (1.36, 10.05)] were positively associated. Two doses lowered the odds of unexplained sudden death [0.51 (0.28, 0.91)], whereas single dose did not.
Interpretation conclusions: COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviors increased the likelihood of unexplained sudden death.
{"title":"Factors associated with unexplained sudden deaths among adults aged 18-45 years in India - A multicentric matched case-control study.","authors":"Manickam Ponnaiah, Tarun Bhatnagar, Rizwan Suliankachi Abdulkader, Rajalakshmi Elumalai, Janani Surya, Kathiresan Jeyashree, Muthusamy Santhosh Kumar, Ranjithkumar Govindaraju, Jeromie Wesley Vivian Thangaraj, Hari Krishan Aggarwal, Suresh Balan, Tridip Dutta Baruah, Ayan Basu, Yogita Bavaskar, Ajeet Singh Bhadoria, Ashish Bhalla, Pankaj Bhardwaj, Rachana Bhat, Jaya Chakravarty, Gina Maryann Chandy, Bal Kishan Gupta, Rakesh Kakkar, Ali Hasan Faiz Karnam, Sushila Kataria, Janakkumar Khambholja, Dewesh Kumar, Nithin Kumar, Monaliza Lyngdoh, M Selva Meena, Kedar Mehta, M P Sheethal, Subhasis Mukherjee, Anuj Mundra, Arun Murugan, Seetharaman Narayanan, Balamurugan Nathan, Jutika Ojah, Pushpa Patil, Sunita Pawar, A Charles Pon Ruban, R Vadivelu, Rishabh Kumar Rana, S Nagendra Boopathy, S Priya, Saroj Kumar Sahoo, Arti Shah, Mohammad Shameem, Karthikeyan Shanmugam, Sachin K Shivnitwar, Abhishek Singhai, Saurabh Srivastava, Sudheera Sulgante, Arunansu Talukdar, Alka Verma, Rajaat Vohra, Rabbanie Tariq Wani, Bhargavi Bathula, Gayathri Kumari, Divya Saravana Kumar, Aishwariya Narasimhan, N C Krupa, Thirumaran Senguttuvan, Parvathi Surendran, Dharsikaa Tamilmani, Alka Turuk, Gunjan Kumar, Aparna Murkherjee, Rakesh Aggarwal, Manoj Vasant Murhekar","doi":"10.4103/ijmr.ijmr_2105_23","DOIUrl":"10.4103/ijmr.ijmr_2105_23","url":null,"abstract":"<p><strong>Background objectives: </strong>In view of anecdotal reports of sudden unexplained deaths in India's apparently healthy young adults, linking to coronavirus disease 2019 (COVID-19) infection or vaccination, we determined the factors associated with such deaths in individuals aged 18-45 years through a multicentric matched case-control study.</p><p><strong>Methods: </strong>This study was conducted through participation of 47 tertiary care hospitals across India. Cases were apparently healthy individuals aged 18-45 years without any known co-morbidity, who suddenly (<24 h of hospitalization or seen apparently healthy 24 h before death) died of unexplained causes during 1 st October 2021-31 st March 2023. Four controls were included per case matched for age, gender and neighborhood. We interviewed/perused records to collect data on COVID-19 vaccination/infection and post-COVID-19 conditions, family history of sudden death, smoking, recreational drug use, alcohol frequency and binge drinking and vigorous-intensity physical activity two days before death/interviews. We developed regression models considering COVID-19 vaccination ≤42 days before outcome, any vaccine received anytime and vaccine doses to compute an adjusted matched odds ratio (aOR) with 95 per cent confidence interval (CI).</p><p><strong>Results: </strong>Seven hundred twenty nine cases and 2916 controls were included in the analysis. Receipt of at least one dose of COVID-19 vaccine lowered the odds [aOR (95% CI)] for unexplained sudden death [0.58 (0.37, 0.92)], whereas past COVID-19 hospitalization [3.8 (1.36, 10.61)], family history of sudden death [2.53 (1.52, 4.21)], binge drinking 48 h before death/interview [5.29 (2.57, 10.89)], use of recreational drug/substance [2.92 (1.1, 7.71)] and performing vigorous-intensity physical activity 48 h before death/interview [3.7 (1.36, 10.05)] were positively associated. Two doses lowered the odds of unexplained sudden death [0.51 (0.28, 0.91)], whereas single dose did not.</p><p><strong>Interpretation conclusions: </strong>COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviors increased the likelihood of unexplained sudden death.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10793826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138176102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-09-25DOI: 10.4103/ijmr.ijmr_1870_23
Soumitra Shankar Datta
{"title":"Children with cancer: Are we healing the body & missing the mind?","authors":"Soumitra Shankar Datta","doi":"10.4103/ijmr.ijmr_1870_23","DOIUrl":"10.4103/ijmr.ijmr_1870_23","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10793819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71481076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background objectives: Despite several adversities imposed by the COVID-19 pandemic, it was crucial to sustain research having public health relevance such as investigations around sickle cell disease (SCD). Against this background, an ongoing ICMR-multicentric study for newborn screening of SCD in the tribal population at Model Rural Health Research Unit (MRHRU-Dahanu) in Palghar District, Maharashtra constituted the current study setting. This was a descriptive study wherein, certain measures were undertaken and strategies were developed in view of the challenges in newborn screening for SCD due to the COVID-19 pandemic during December 2019-September 2021 at Sub District Hospital, MRHRU-Dahanu.
Methods: During the onset of the pandemic, (December 2019-March 2020), the follow up was possible in 26.7 per cent (20/75) of the newborns. Subsequently, challenges such as travel restrictions, fear of COVID-19, shortage of staff were experienced with respect to enrolment and follow up visits.
Results: After implementing certain pragmatic strategies (ASHA involvement, usage of virtual platform and flexible visits), follow up rate increased to 47.5 per cent (66/139) between July 2020-April 2021 (post first lockdown) and to 66 per cent (65/98) during the second wave (May 2021-August 2021).
Interpretation conclusions: The study emphasizes the importance of network building, use of virtual platform and engaging health workers in tribal settings. Such pragmatic approaches have the potential to pave a path for further implementation research involving specific interventions to improve health outcomes in tribal settings.
{"title":"Challenges in screening for sickle cell disease among newborns from the tribal region of Palghar, Maharashtra during the COVID-19 pandemic.","authors":"Suchitra Surve, Sanjay Chauhan, Ragini Kulkarni, Neha Salvi, Anita Nadkarni, Manisha Madkaikar, Khushbu Chaudhary, Abhijit Chavan, Dayanand Suryavanshi, Anil Thorat, Harpreet Kaur","doi":"10.4103/ijmr.ijmr_3220_21","DOIUrl":"10.4103/ijmr.ijmr_3220_21","url":null,"abstract":"<p><strong>Background objectives: </strong>Despite several adversities imposed by the COVID-19 pandemic, it was crucial to sustain research having public health relevance such as investigations around sickle cell disease (SCD). Against this background, an ongoing ICMR-multicentric study for newborn screening of SCD in the tribal population at Model Rural Health Research Unit (MRHRU-Dahanu) in Palghar District, Maharashtra constituted the current study setting. This was a descriptive study wherein, certain measures were undertaken and strategies were developed in view of the challenges in newborn screening for SCD due to the COVID-19 pandemic during December 2019-September 2021 at Sub District Hospital, MRHRU-Dahanu.</p><p><strong>Methods: </strong>During the onset of the pandemic, (December 2019-March 2020), the follow up was possible in 26.7 per cent (20/75) of the newborns. Subsequently, challenges such as travel restrictions, fear of COVID-19, shortage of staff were experienced with respect to enrolment and follow up visits.</p><p><strong>Results: </strong>After implementing certain pragmatic strategies (ASHA involvement, usage of virtual platform and flexible visits), follow up rate increased to 47.5 per cent (66/139) between July 2020-April 2021 (post first lockdown) and to 66 per cent (65/98) during the second wave (May 2021-August 2021).</p><p><strong>Interpretation conclusions: </strong>The study emphasizes the importance of network building, use of virtual platform and engaging health workers in tribal settings. Such pragmatic approaches have the potential to pave a path for further implementation research involving specific interventions to improve health outcomes in tribal settings.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10793820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138440627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-14DOI: 10.4103/ijmr.ijmr_1509_22
Atul Prabhakar Kulkarni
{"title":"Book Review.","authors":"Atul Prabhakar Kulkarni","doi":"10.4103/ijmr.ijmr_1509_22","DOIUrl":"https://doi.org/10.4103/ijmr.ijmr_1509_22","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-06DOI: 10.4103/0971-5916.384245
Jatin Sharma, C S Gautam, Harmanjit Singh, Jagjit Singh
{"title":"Authors' response.","authors":"Jatin Sharma, C S Gautam, Harmanjit Singh, Jagjit Singh","doi":"10.4103/0971-5916.384245","DOIUrl":"https://doi.org/10.4103/0971-5916.384245","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41178714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.4103/ijmr.ijmr_2193_22
Vipin M Vashishtha
{"title":"Immunization guidelines and applications.","authors":"Vipin M Vashishtha","doi":"10.4103/ijmr.ijmr_2193_22","DOIUrl":"10.4103/ijmr.ijmr_2193_22","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49677079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.4103/ijmr.ijmr_1689_23
Daniel José Piñeiro, Jagat Narula, Borjana Pervan, Lisa Hadeed
{"title":"World Heart Day 2023: Knowing your heart.","authors":"Daniel José Piñeiro, Jagat Narula, Borjana Pervan, Lisa Hadeed","doi":"10.4103/ijmr.ijmr_1689_23","DOIUrl":"10.4103/ijmr.ijmr_1689_23","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10720962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49677099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.4103/ijmr.ijmr_2591_22
Ranjan Ramasamy
The SARS-CoV-2, a highly infectious positive strand RNA virus first identified in December 2019, has produced multiple genetic variants that have rapidly and sequentially spread worldwide during the coronavirus disease 2019 (COVID-19) pandemic. Genetic changes in SARS-CoV-2 for greater infectivity, replication and transmission were selected during the early stages of the pandemic. More recently, after widespread infection and vaccination, SARS-CoV-2 variants that evade antigen-specific adaptive immunity, have begun to be selected. This article provides an overview of the molecular immunological and virological factors underlying the origin and global spread of important SARS-CoV-2 variant lineages.
{"title":"Overview of immunological & virological factors driving the evolution & global spread of SARS-CoV-2 variants.","authors":"Ranjan Ramasamy","doi":"10.4103/ijmr.ijmr_2591_22","DOIUrl":"10.4103/ijmr.ijmr_2591_22","url":null,"abstract":"<p><p>The SARS-CoV-2, a highly infectious positive strand RNA virus first identified in December 2019, has produced multiple genetic variants that have rapidly and sequentially spread worldwide during the coronavirus disease 2019 (COVID-19) pandemic. Genetic changes in SARS-CoV-2 for greater infectivity, replication and transmission were selected during the early stages of the pandemic. More recently, after widespread infection and vaccination, SARS-CoV-2 variants that evade antigen-specific adaptive immunity, have begun to be selected. This article provides an overview of the molecular immunological and virological factors underlying the origin and global spread of important SARS-CoV-2 variant lineages.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10720969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Identification of three novel mutations in <i>SLCO2A1</i> in Asian-Indians with Pachydermoperiostosis.","authors":"Divya Pasumarthi, Priya Ranganath, Kausik Mandal, N Dhanya Lakshmi, Ashwin Dalal, Shagun Aggarwal","doi":"10.4103/ijmr.ijmr_3353_21","DOIUrl":"10.4103/ijmr.ijmr_3353_21","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10720970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49677078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salt plays a critical role in India's past as well as its present, from Dandi March to its role as a vehicle for micronutrient fortification. However, excess salt intake is a risk factor for high blood pressure and cardiovascular diseases (CVDs). Indians consume double the World Health Organization recommended daily salt (<5 g). India has committed to a 30 per cent reduction in sodium intake by 2025. Evidence based strategies for population sodium intake reduction require a moderate reduction in salt in - home cooked foods, packaged foods and outside-home foods. Reducing the sodium content in packaged food includes policy driven interventions such as front-of-package warning labels, food reformulation, marketing restrictions and taxation on high sodium foods. For foods outside of the home, setting standards for foods purchased and served by schemes like mid-day meals can have a moderate impact. For home cooked foods (the major source of sodium), strategies include advocacy for reducing salt intake. In addition to mass media campaigns for awareness generation, substituting regular salt with low sodium salt (LSS) has the potential to reduce salt intake even in the absence of a major shift in consumer behaviour. LSS substitution effectively lowers blood pressure and thus reduces the risk of CVDs. Further research is required on the effect of LSS substitutes on patients with chronic kidney disease. India needs an integrated approach to sodium reduction that uses evidence based strategies and can be implemented sustainably at scale. This will be possible only through scientific research, governmental leadership and a responsive evidence-to-action approach through a multi-stakeholder coalition.
{"title":"India's tryst with salt: Dandi march to low sodium salts.","authors":"Roopa Shivashankar, Manika Sharma, Meenakshi Sharma, Swati Bhardwaj, Nicole Ide, Laura Cobb, Balram Bhargava","doi":"10.4103/ijmr.ijmr_1059_23","DOIUrl":"10.4103/ijmr.ijmr_1059_23","url":null,"abstract":"<p><p>Salt plays a critical role in India's past as well as its present, from Dandi March to its role as a vehicle for micronutrient fortification. However, excess salt intake is a risk factor for high blood pressure and cardiovascular diseases (CVDs). Indians consume double the World Health Organization recommended daily salt (<5 g). India has committed to a 30 per cent reduction in sodium intake by 2025. Evidence based strategies for population sodium intake reduction require a moderate reduction in salt in - home cooked foods, packaged foods and outside-home foods. Reducing the sodium content in packaged food includes policy driven interventions such as front-of-package warning labels, food reformulation, marketing restrictions and taxation on high sodium foods. For foods outside of the home, setting standards for foods purchased and served by schemes like mid-day meals can have a moderate impact. For home cooked foods (the major source of sodium), strategies include advocacy for reducing salt intake. In addition to mass media campaigns for awareness generation, substituting regular salt with low sodium salt (LSS) has the potential to reduce salt intake even in the absence of a major shift in consumer behaviour. LSS substitution effectively lowers blood pressure and thus reduces the risk of CVDs. Further research is required on the effect of LSS substitutes on patients with chronic kidney disease. India needs an integrated approach to sodium reduction that uses evidence based strategies and can be implemented sustainably at scale. This will be possible only through scientific research, governmental leadership and a responsive evidence-to-action approach through a multi-stakeholder coalition.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10720971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49677096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}