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AUTHORíS REPLY
Year : 2017  |  Volume : 61  |  Issue : 1  |  Page : 61  

A comparative study of skeletal fluorosis among adults in two study areas of Bangarpet Taluk, Kolar


1 Assistant Professor, Department of Community Medicine, BGS Global Institute of Medical Sciences, Bengaluru, India
2 Professor and Head, Departments of Community Medicine, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
3 Professor, Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
4 Professor, Radio-Diagnosis, Sri Devaraj Urs Medical College, Kolar, Karnataka, India

Date of Web Publication16-Feb-2017

Correspondence Address:
M N Shruthi
Department of Community Medicine, BGS Global Institute of Medical Sciences, #67, BGS Health and Education City, Uttarahalli Road, Kengeri, Bengaluru - 560 060, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.200260

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How to cite this article:
Shruthi M N, Santhuram AN, Arun H S, Kishore Kumar B N. A comparative study of skeletal fluorosis among adults in two study areas of Bangarpet Taluk, Kolar. Indian J Public Health 2017;61:61

How to cite this URL:
Shruthi M N, Santhuram AN, Arun H S, Kishore Kumar B N. A comparative study of skeletal fluorosis among adults in two study areas of Bangarpet Taluk, Kolar. Indian J Public Health [serial online] 2017 [cited 2017 Mar 28];61:61. Available from: http://www.ijph.in/text.asp?2017/61/1/61/200260

Sir,

We appreciate the keen interest shown and efforts taken by the author in expressing their views and concerns in letter to editor with reference to the article titled, “A comparative study of skeletal fluorosis among adults in two study areas of Bangarpet taluk, Kolar.” We are hereby presenting our views in response to the points raised by the author.

The current study does not intend to estimate the cumulative levels of fluoride in the water, and the fluoride levels have been measured only at one point of time. Hence, the differential exposure in terms of duration and levels of fluoride cannot be ruled out. As with any other toxic substance, individual susceptibility to fluoride varies considerably across the population. It has been documented that some individuals can develop skeletal fluorosis despite having “safe” levels of fluoride in their bones and without any known excessive exposure to fluoride. Individuals receiving the same dose of fluoride can exhibit dramatically different bone responses and these have been attributed to genetic factors. Such genetic susceptibility to fluoride has already been documented among inbred mice, and the same has been expected even in the population.[1],[2]

Although income, occupation, and education are a way to assess socioeconomic data, the socioeconomic scale used here is modified B. G. Prasad scale which only has income into consideration. As B. G. Prasad scale focuses on income and not on other possessions, it does not give the realistic picture of living standards/socioeconomic status.[3] Hence, the current socioeconomic scale cannot be considered as a definite index of nutritional status. Malnutrition, as it is known, is multifactorial, and in the present study, malnourished include underweight, overweight, and obese.[4] Use of food rich in calcium, iron, Vitamin “C,” anti-oxidants, magnesium, and zinc is promoted in fluorosis; hence, specific nutritional deficiencies play an important role.[5]

All the other factors as mentioned in the discussion in the first line are not from the present study finding and those are the factors quoted from the other studies.[6],[7]

In the present study, the following aspects have already been highlighted: (1) Detailed diet survey to confirm the cause of fluorosis could not be performed due to operational feasibility and there is a further requirement of an in-depth evaluation on the nutritional components of diet, specific nutritional deficiency, and feeding habits of the subjects residing in the study areas. (2) The actual role of confounders or effect modifiers needs a detailed evaluation through higher study designs.



 
   References Top

1.
Kobayashi CA, Leite AL, Peres-Buzalaf C, Carvalho JG, Whitford GM, Everett ET, et al. Bone response to fluoride exposure is influenced by genetics. PLoS One 2014;9:e114343.  Back to cited text no. 1
    
2.
Chachra D, Limeback H, Willett TL, Grynpas MD. The long-term effects of water fluoridation on the human skeleton. J Dent Res 2010;89:1219-23.  Back to cited text no. 2
    
3.
Ramesh Masthi NR, Gangaboraiah, Kulkarni P. An exploratory study on socio economic status scales in a rural and urban setting. J Family Med Prim Care 2013;2:69-73.  Back to cited text no. 3
    
4.
World Health Organization. Nutrition Challenges. Geneva: World Health Organization; c2016. Available from: http://www.who.int/nutrition/challenges/en/. [Last cited on 2016 Nov 10].  Back to cited text no. 4
    
5.
Department of Health and Family Welfare, Ministry of Health and Family Welfare, Government of India. National Programme for Prevention and Control of Fluorosis (NPPCF). Available from: http://www.mohfw.nic.in/WriteReadData/l892s/569857456332145987456.pdf. [Last updated on 2016 Nov 09; Last cited on 2016 Nov 10].  Back to cited text no. 5
    
6.
Mamatha P, Rao SM. Geochemistry of fluoride rich in groundwater in Kolar and Tumkur districts of Karnataka. Environ Earth Sci 2010;61:131-42.  Back to cited text no. 6
    
7.
Susheela AK, editor. Fluorosis: An easily preventable disease through practice of interventions. In: Doctor's Handbook. 1st ed. New Delhi: Ministry of Health and Family Welfare (GOI), WHO India Country Office; 2005. p. 1-21.  Back to cited text no. 7
    




 

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